Endoscopic Submucosal Dissection (ESD) Versus Simplified/Hybrid ESD

Toyonaga, Takashi; Man-i, Mariko; Morita, Yoshinori; Azuma, Takeshi

doi:10.1016/j.giec.2013.11.004

Cited by 78 publications

(50 citation statements)

References 16 publications

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“…The ESD procedure was classified as one of two methods: ESD and simplified ESD. Simplified ESD was defined as a procedure that involves snaring after the circumferential incision and that is characterized by sufficient submucosal dissection . Bleeding after an ESD procedure was defined as ESD‐related bleeding with hematochezia, melena, hypotension, or a decreased hemoglobin level (≥ 2).…”

Section: Methodsmentioning

confidence: 99%

Effect of submucosal fibrosis on endoscopic submucosal dissection of colorectal tumors: Pathologic review of 173 cases

Lee

Kim

Sung

et al. 2015

J of Gastro and Hepatol

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Section: Methodsmentioning

confidence: 99%

Effect of submucosal fibrosis on endoscopic submucosal dissection of colorectal tumors: Pathologic review of 173 cases

Lee

Kim

Sung

et al. 2015

J of Gastro and Hepatol

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“…Hybrid ESD-EMR ESD and EMR are not mutually exclusive and a hybrid procedure can be an acceptable compromise, enabling larger individual polyp pieces to be resected than the standard PEMR technique alone 113,[122][123][124] . During the hybrid procedure, the mucosa around the polyp is circumferentially incised using an endoscopic knife, followed by partial submucosal dissection to undermine and expose the lesion.…”

Section: Esd Follow-upmentioning

confidence: 99%

Endoscopic mucosal resection and endoscopic submucosal dissection of large colonic polyps

Saunders

Tsiamoulos

2016

Nat Rev Gastroenterol Hepatol

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Almost all large and complex colorectal polyps can now be resected endoscopically. Piecemeal endoscopic mucosal resection (PEMR) is an established technique with fairly low complication risk and good short-term and medium-term outcomes. Several modifications to the basic injection and snare technique have been developed contributing to safer and more complete resections. Delayed bleeding requiring reintervention is the most troublesome complication in 2-7% of patients, particularly in those with comorbidities and large, right-sided polyps. Endoscopic submucosal dissection (ESD) has become popular in Japan and has theoretical advantages over PEMR in providing a complete, en bloc excision for accurate histological staging and reduced local recurrence. These advantages come at the cost of a more complex, expensive and time-consuming procedure with a higher risk of perforation, particularly early in the procedure learning curve. These factors have contributed to the slow adoption of ESD in the West and the challenge to develop new devices and endoscopic platforms that will make ESD easier and safer. Currently, ESD indications are limited to large rectal lesions, in which procedural complications are easily managed, and for colorectal polyps with a high risk of containing tiny foci of early submucosally invasive cancer, whereby ESD may be curative compared with PEMR.

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“…The choice of a specific snare is influenced by lesion size, morphology, and location and personal preference (Fig. When lesions are difficult to access via the mucosal plane, hybrid ESD may achieve better results than EMR [10]. While EMR techniques mainly involve polyp removal with snare or strip biopsy, the hybrid ESD technique uses a circumferential mucosal incision followed by en bloc resection of the lesion with snare (see Video 16.1).…”

Section: Snare Selectionmentioning

confidence: 99%

Endoscopic Mucosal Dissection

Benlice

Görgün

2017

Advanced Colonoscopy and Endoluminal Surgery

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Electronic supplementary material: Supplementary material is available in the online version of this chapter at 10.1007/978-3-319-48370-2_16. Videos can also be accessed at http://www.springerimages.com/ videos/978-3-319-48368-9. 16 Abbreviations CT Computerized tomography EMR Endoscopic mucosal resection ESD Endoscopic submucosal dissection LCS Laparoscopic colorectal surgery SM Submucosal invasion status Key Points• Up to 15% of colon polyps require advanced polypectomy techniques due to their size, location, or appearance; ESD has unique advantages over other methods in this setting. • The colonoscopy report and pathology results should be reviewed prior to ESD as these details can influence treatment decisions. • Polyps should be localized first endoscopically and marked using hyperosmolar injectate diluted with methylene blue. • Bleeding encountered during dissection should be coagulated immediately and potential perforations should be closed using endoclips.• If a target lesion demonstrates features of malignancy, the procedure can be converted to laparoscopic colectomy. • If endoscopic submucosal dissection is successful, but final pathology reveals carcinoma, patients may then require colectomy.

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Endoscopic Submucosal Dissection (ESD) Versus Simplified/Hybrid ESD

Cited by 78 publications

References 16 publications

Effect of submucosal fibrosis on endoscopic submucosal dissection of colorectal tumors: Pathologic review of 173 cases

Effect of submucosal fibrosis on endoscopic submucosal dissection of colorectal tumors: Pathologic review of 173 cases

Endoscopic mucosal resection and endoscopic submucosal dissection of large colonic polyps

Endoscopic Mucosal Dissection

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