| Theme | Colorectal endoscopic submucosal dissection | |
|---|---|---|
| Title | Techniques for and difficulties with Flex knife ESD | |
| Publish Date | 2006/11 | |
| Author | Naohisa Yahagi | Department of Gastroenterology, Toranomon Hospital |
| Author | Takafumi Ohtsuka | Department of Gastroenterology, Toranomon Hospital |
| Author | Syu Hoteiya | Department of Gastroenterology, Toranomon Hospital |
| Author | Toshiro Iizuka | Department of Gastroenterology, Toranomon Hospital |
| Author | Hideo Mizuno | Department of Gastroenterology, Toranomon Hospital |
| Author | Mitsuyo Hashimoto | Department of Gastroenterology, Toranomon Hospital |
| [ Summary ] | Endoscopic submucosal dissection (ESD) has become a widely accepted practice in Japan. Many endoscopists resect large, difficult lesions with this technique, including colonic lesions. ESD is a wonderful technique, enabling us to resect whole lesions in an en-bloc fashion, but it involves higher risks of complications. Good positioning and maneuverability of the scope are essential for accomplishment of safe, reliable ESD procedures. The Flex knife is the best device for colonic ESD, since it is easy to control due to its soft, flexible nature and also because the knife length is adjustable according to circumstances. We usually perform mucosal incisions and submucosal dissections, after producing an adequate submucosal fluid cushion, with a knife length of approximately 1 mm. It is a very safe procedure if we can achieve good visibility of the operating field and good maneuverability of the endoscope. ESD has tremendous potential in conducting radical resection of superficial tumors in the entire digestive tract. However, colonic ESD is still a very advanced form of therapeutic endoscopy and skillful practioners must be chosen for the safe, effective performance of ESD. |
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