| Theme |
Colorectal endoscopic submucosal dissection |
| Title |
Techniques for and challenges with colorectal ESD -- difference between stomach and colorectum : Needle knife and ST hood |
| Author |
Hiroto Kita |
Department of Gastroenterology, Jichi Medical University |
| Author |
Hironori Yamamoto |
Department of Gastroenterology, Jichi Medical University |
| Author |
Tomohiko Miyata |
Department of Gastroenterology, Jichi Medical University |
| Author |
Keijiro Sunada |
Department of Gastroenterology, Jichi Medical University |
| Author |
Michiko Iwamoto |
Department of Gastroenterology, Jichi Medical University |
| [ Summary ] |
En bloc resection of target lesions with precise demarcation is the biggest advantage of using ESD. Precise en bloc resection enables precise judgement for complete resection based on accurate pathological diagnose. Thin, soft colonic walls are one factor related to difficulties with colonic ESD. A sodium hyaluronate solution is very useful for submucosal injection to provide thickness and some stiffness to the thin, soft colonic wall in order to perform ESD safely. We use a needle knife for mucosal incision and submucosal dissection. A transparent hood is also helpful when attached to the endoscope tip to assist with incision and dissection. A strategy to maintain submucosal thickening throughout the procedure and employment of gravity are also important factors for successful ESD. ESD can be performed safely, even in the colon, with appropriate techniques. Future development and improvements in instruments and techniques will promote further colonic ESD applications. |