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How to Deal with Difficult ESD?

How to Deal with Difficult ESD?

21 Aug 2021 10:34 10:41
(7 mins)
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How to deal with difficult ESD?
In this presentation I will talk about tips of colorectal ESD for case with severe fibrosis. (1) ST hood: This hood is cone type and easy to enter submucosal layer and can make a good situation at the submucosal layer. (2) SO-clip for traction of the lesion. Traction of lesion is very effective to get a good situation of SM layer to dissect. Clip with string is also useful, however, colon is complicated run-structure and sometimes non-effective. SO-clip can tract the lesion to any direction. (3) The needle-in technique of Dual knife: As for Dual knife, even in needle-in state, we can dissect submucosal layer and effective to stop bleeding from small vessel. Because as for the Dual knife, even in needle-in–state knife tip is a little extended from the knife tube tip, 0.1 to 0.3 mm. This point is completely different from the Flush knife.
To use SO-Clip, at first we conduct the circumferential normal mucosa incision around the lesion where no fibrosis. After circumferential normal mucosa incision, we add submucosal dissection. If the situation of approach to muscle layer is perpendicular, Dual knife needle-in technique is useful. To avoid over burning effect at the dissection area, basically this technique should be used under the normal mucosa not under the lesion.

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