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History of Endoscopic Resection - Challenge to Difficulties and the Future Perspective

History of Endoscopic Resection - Challenge to Difficulties and the Future Perspective

21 Aug 2021 09:50 10:15
(25 mins)
Takuji Gotoda Speaker
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Endoscopic resection to treat cancer is perhaps the most gratifying endoscopy to perform because of its minimally invasive curative potentials. Endoscopic resection allows complete pathological staging of cancer. The optimal staging method of early gastrointestinal cancer is to evaluate the pathology of en bloc resected material. The first endoscopic resection was reported in colorectal polypectomy using a high-frequency electric surgical unit. Several EMR techniques have been reported and widely accepted in the early 90’ as a being relatively simple procedure. However, these techniques cannot be used to remove lesions en bloc larger than 2cm. To resect large lesions en bloc and allow a precise pathological staging, ESD has already been 20 years old as at a revolutionary procedure. The term "generalization" is synonymous with the ability of anyone to complete the procedure safely and reliably. The basic operation of surgery is triangulation. However, an endoscopic approach is only through the scope, and an approach from different axial directions is impossible. Although various methods have been reported for proper traction, large-scale equipment and invasive methods have not been generalized. Recently, traction methods using inexpensive dental floss and endoscopic clips are widespread in Japan. Appropriate traction facilitates dissection, improves visibility during bleeding, shortens the treatment time and reduces the incidence of complications such as perforation. Nowadays, this method has become a standard method. In the case of teaching beginners, it is much safer and easier to combinate traction and Clutch Cutter were very compatible. In a sense, if we think of it as a large biopsy forceps, it is not only easy for us but also very easy from the standpoint of teaching. This concept will make ESD a general procedure rather than an experienced procedure.

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