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. 2011 Aug 21;17(31):3580-4.
doi: 10.3748/wjg.v17.i31.3580.

Do you have what it takes for challenging endoscopic submucosal dissection cases?

Kyoung-Oh Kim  1 , Sung Jung Kim, Tae Hyeon Kim, Jong-Jae Park
Affiliations

Do you have what it takes for challenging endoscopic submucosal dissection cases?

Kyoung-Oh Kim et al. World J Gastroenterol. .

Abstract

Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric cancer (EGC), especially in Korea and Japan. The criteria for the therapeutic use of ESD for EGC have been expanded recently. However, attention should be drawn to the technical feasibility of the ESD treatment which depends on a lesion's location, size or fibrosis level, or operator's experience. In the case of a lesion with a high level of difficulty, a more experienced operator is required. Thus, the treatment for a lesion with a high level of difficulty should be performed according to the degree of the operator's experience. In this paper, the authors describe the ESD procedure for lesions with a high level of difficulty.

Keywords: Anatomical location; Endoscopic submucosal dissection; Technical feasibility.

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Figures

Figure 1
Figure 1
Lesion at the cardia, just below the gastroesophageal junction. A: Retroflexed view of the cardia; B: A circumferential incision was made from the oral to the anal side, which is then vulnerable to bleeding; C: Submucosal dissection from the anal to the oral side; D: The lesion was completely resected.
Figure 2
Figure 2
Lesion at the fundus. A: The lesion was located between the fundus and the anterior side of the high body; B: Submucosal dissection was performed from the cardia to the fundus.
Figure 3
Figure 3
Lesion at the pyloric channel extending to the duodenal bulb. A: Nodular elevated lesion involving the pyloric channel; B: Polypoid mass lesion at the duodenal bulb, retroflexed view; C: Incision and submucosal dissection were performed from the duodenal bulb to the antrum; D: The 180° circumferential dissection was completed; E: The en bloc resection was completed.
Figure 4
Figure 4
Lesion at the duodenum. A: Two flat elevated lesions at the duodenal bulb; B: Circumferential incision; C: Submucosal dissection (the lifting of the lesion after submucosal injection was limited); D: The en bloc resection was completed.
See this image and copyright information in PMC

References

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