Endoscopic submucosal dissection: How to be more efficient?

Endoscopic submucosal dissection (ESD) allows an “en bloc” resection with safety margins (R0 resection) regardless of the size of the lesion. However, while R0 brings a real benefit for the patient, it is not considered sufficient by many experts to justify the technical difficulties and the longer...

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Autores principales:	Thomas Lambin, Jérôme Rivory, Timothée Wallenhorst, Romain Legros, Frédéric Monzy, Jérémie Jacques, Mathieu Pioche
Formato:	article
Lenguaje:	EN
Publicado:	Georg Thieme Verlag KG 2021
Materias:	Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/4d4016688a6043ed8acfff490f6fc4d6
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spelling	oai:doaj.org-article:4d4016688a6043ed8acfff490f6fc4d62021-11-13T00:00:31ZEndoscopic submucosal dissection: How to be more efficient?2364-37222196-973610.1055/a-1554-3884https://doaj.org/article/4d4016688a6043ed8acfff490f6fc4d62021-11-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.1055/a-1554-3884https://doaj.org/toc/2364-3722https://doaj.org/toc/2196-9736Endoscopic submucosal dissection (ESD) allows an “en bloc” resection with safety margins (R0 resection) regardless of the size of the lesion. However, while R0 brings a real benefit for the patient, it is not considered sufficient by many experts to justify the technical difficulties and the longer procedure time compared to piecemeal mucosectomy. The aims of this review are to provide several technical and strategical tips to help you save time and become comfortable during ESD procedures. ESD is divided into several intertwined phases: injection, incision, access to the submucosae, and submucosal dissection itself. During injection there are some mistakes that should not be made: a superficial injection, or on the contrary, a too deep injection. A good needle and good injection technique are mandatory. Some techniques, such as repeated injection or prolonged lifting solution, can help maintain the lift. After this step, mucosal incision can be made, taking care to have a good margin to allow an R0 resection. Starting the mucosal incision from a small point allows calibration of the depth of the incision and then obtaining a nice incision. Trimming is also very important to widen submucosal access. Then comes the submucosal dissection itself. Strategies such as the tunnel strategy or the pocket creation method can help to facilitate dissection, but more importantly, traction systems have become unavoidable, especially in the stomach and colon. Most common complications are bleeding and perforation, and they usually can be managed endoscopically.Thomas LambinJérôme RivoryTimothée WallenhorstRomain LegrosFrédéric MonzyJérémie JacquesMathieu PiocheGeorg Thieme Verlag KGarticleDiseases of the digestive system. GastroenterologyRC799-869ENEndoscopy International Open, Vol 9, Iss 11, Pp E1720-E1730 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Diseases of the digestive system. Gastroenterology RC799-869 Thomas Lambin Jérôme Rivory Timothée Wallenhorst Romain Legros Frédéric Monzy Jérémie Jacques Mathieu Pioche Endoscopic submucosal dissection: How to be more efficient?
description	Endoscopic submucosal dissection (ESD) allows an “en bloc” resection with safety margins (R0 resection) regardless of the size of the lesion. However, while R0 brings a real benefit for the patient, it is not considered sufficient by many experts to justify the technical difficulties and the longer procedure time compared to piecemeal mucosectomy. The aims of this review are to provide several technical and strategical tips to help you save time and become comfortable during ESD procedures. ESD is divided into several intertwined phases: injection, incision, access to the submucosae, and submucosal dissection itself. During injection there are some mistakes that should not be made: a superficial injection, or on the contrary, a too deep injection. A good needle and good injection technique are mandatory. Some techniques, such as repeated injection or prolonged lifting solution, can help maintain the lift. After this step, mucosal incision can be made, taking care to have a good margin to allow an R0 resection. Starting the mucosal incision from a small point allows calibration of the depth of the incision and then obtaining a nice incision. Trimming is also very important to widen submucosal access. Then comes the submucosal dissection itself. Strategies such as the tunnel strategy or the pocket creation method can help to facilitate dissection, but more importantly, traction systems have become unavoidable, especially in the stomach and colon. Most common complications are bleeding and perforation, and they usually can be managed endoscopically.
format	article
author	Thomas Lambin Jérôme Rivory Timothée Wallenhorst Romain Legros Frédéric Monzy Jérémie Jacques Mathieu Pioche
author_facet	Thomas Lambin Jérôme Rivory Timothée Wallenhorst Romain Legros Frédéric Monzy Jérémie Jacques Mathieu Pioche
author_sort	Thomas Lambin
title	Endoscopic submucosal dissection: How to be more efficient?
title_short	Endoscopic submucosal dissection: How to be more efficient?
title_full	Endoscopic submucosal dissection: How to be more efficient?
title_fullStr	Endoscopic submucosal dissection: How to be more efficient?
title_full_unstemmed	Endoscopic submucosal dissection: How to be more efficient?
title_sort	endoscopic submucosal dissection: how to be more efficient?
publisher	Georg Thieme Verlag KG
publishDate	2021
url	https://doaj.org/article/4d4016688a6043ed8acfff490f6fc4d6
work_keys_str_mv	AT thomaslambin endoscopicsubmucosaldissectionhowtobemoreefficient AT jeromerivory endoscopicsubmucosaldissectionhowtobemoreefficient AT timotheewallenhorst endoscopicsubmucosaldissectionhowtobemoreefficient AT romainlegros endoscopicsubmucosaldissectionhowtobemoreefficient AT fredericmonzy endoscopicsubmucosaldissectionhowtobemoreefficient AT jeremiejacques endoscopicsubmucosaldissectionhowtobemoreefficient AT mathieupioche endoscopicsubmucosaldissectionhowtobemoreefficient
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Endoscopic submucosal dissection: How to be more efficient?

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