A case of improved visibility with gel immersion in the presence of ongoing bleeding during colorectal endoscopic submucosal dissection

Abstract

Video 1A case of improved visibility with gel immersion in the presence of ongoing bleeding during colorectal endoscopic submucosal dissection.

Keywords: ESD, endoscopic submucosal dissection.

Figure 1

The lesion is pulled up to the opposite side of the colonic wall by an S-O clip. Sufficient traction on the lesion allows visualization of the tissue cutting line of the submucosal layer.

Figure 2

Mild fibrosis and vascular network in the submucosa. Mild fibrosis and a vascular network are observed beneath the center of the lesion.

Figure 3

Immediate bleeding during endoscopic submucosal dissection. The injected water mixes instantaneously with blood, making it difficult to secure a clear visual field.

Figure 4

Use of gel immersion endoscopy. After gel injection, it becomes easier to secure the visual field, and hemostasis is achieved.

Figure 5

Comparison of indigo carmine injection into gel and saline solution in vitro. The container on the left is filled with gel, and the container on the right is filled with saline solution. Indigo carmine solution, which is assumed to be blood, is infused simultaneously. In the saline solution, the indigo carmine solution diffuses at once, whereas in the gel, the fluidity and diffusivity of the indigo carmine solution are suppressed.