So, we'll talk a little bit about the colonic ESD in the United States, and we can see here when we talk about ESD, we're talking about the submucosal layer, and we're basically focusing in removing the entire lesion in one piece. That's an example here of lesions that are removed by ESD. In the first slide, and I chose this picture just to show the complexity of this procedure. So, in the first slide, we can see here we're using an assisted device for stabilization, we're using another device for grasping, and we're using a specialized knife to dissect the lesion, and you can see here the muscle layer under it, and you are working in a space like two to three millimeters to remove that lesion. Here on the right side here, you can see a very flat polyp removed by EMR before, and you have this fibrosis in the middle, and it's very hard. You can imagine if you're doing EMR, it's very hard to do EMR for a lesion like that. Down here, that's the appendix, and that's another tubular adenoma in the appendix, and you can see here that the lesion is taking the appendiceal orifice, and it's actually closing the appendix, and there's pus coming out. It's a complex lesion. In the past, something like that would be sent for surgery, and here is an example of the end result of removing this lesion with ESD. You will have the polyp completely removed in one piece, and you are going to have all the margin around it very clear and very nice. So these are examples of lesions, lateral spreading tumor, granular or non-granular, specifically non-granular, we want to remove them with ESD, flat lesion, byproduct lesion like this one here, or appendiceal orifice lesions. So there is a need for this in the United States. We see a lot of these lesions, and we'll continue to see more of it. And as we saw from this picture, to do an ESD process, you need a lot of devices. You need an electrosurgical unit, injection devices, resection devices such as snares and knives, ablation devices, hemostasis devices, and you also sometimes need stabilizing devices and tissue opposition devices like clips and other. So if you think about this, it is really costly. But if you also think about the cost of surgery and the cost of going to the OR room to do right or left hemicolectomy, and you see the amount of devices you are using, you will discover that although we are using all these devices, it's still cheaper than going for surgery. So how do you go about that? How can you build a program with all of this? And particularly for ESD, as we see here, you will need a lot of clips. Clips are not that cheap, and that's why we need to develop more and more of these cheaper options. And I know some of the companies now are coming with cheaper clips. Clips were very expensive in the past, and now we can find them at cheaper prices. Stabilizing devices are also important for chronic ESD. For more information, visit www.osho.com

colonic endoscopic submucosal dissection

ESD procedures

United States

challenging lesions

less invasive alternative