Endoskopische Submukosadissektion

Abstract

Endoscopic submucosal dissection (ESD) was developed in Japan but has now also become permanently established in various centers in Europe. ESD is an endoscopic en bloc mucosal resection technique for the treatment of early cancers with a diameter >1 cm and also superficial precancerous lesions, which could only be removed unsatisfactorily in several fragments or with uncertain lateral safety margins using previous loop excision procedures. Using ESD a lesion is excised after circular marking and generous submucosal injection with a safety margin of approximately 5 mm and subsequently resected at the level of the submucosa with a 1-3 mm short diathermic knife. ESD requires high technical skills in interventional endoscopy and is more time-consuming than snare resection techniques. However, numerous studies have shown a clear superiority for ESD with respect to the R0 resection rate and the local recurrence rate. The present article gives a current review of the use of ESD in the upper and lower gastrointestinal tract and demonstrates perspectives of the procedure.

Magnifying Endoscopy with Narrow Band Imaging to Determine the Extent of Resection in Transoral Robotic Surgery of Oropharyngeal Cancer

“…It is generally accepted that the safety margin needed for the resection of superficial lesion is less than that for the resection of invasive cancer in the upper digestive tract. The safety margin needed for the resection of superficial lesion is about 2 mm [ 9 ] to 5 mm [ 10 ] whereas that of invasive cancer is 10 to 15 mm. The boundary of a superficial lesion can be easily identified with ME-NBI, so the combination of ME-NBI with TORS will be beneficial in avoiding excessive resection, especially for the superficial part of the invasive cancer, thus resulting in better functional outcomes, such as swallowing and voice function.…”

Full-Thickness Resection Device for Complex Colorectal Lesions in High-Risk Patients as a Last-Resort Endoscopic Treatment: Initial Clinical Experience and Review of the Current Literature

“…1A ). Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are the current endoscopic treatment options for colorectal adenomas with low-grade dysplasia or high-grade dysplasia, and early mucosal-based cancer [ 1 ]. However, these techniques have limitations in cases of submucosal scarring and fibrosis.…”

Tipps und Tricks für die endoskopische Submukosadissektion

“…Die endoskopische Submukosadissektion (ESD) wurde Ende der 1990er-Jahre in Japan entwickelt und hat in den letzten Jahren eine zunehmende Verbreitung in Europa gefunden (▶ Abb. 1a -f) [1,2]. Wesentliche Vorteile gegenüber der Piecemeal-Schlingenresektion sind die Gewinnung eines ‚en bloc'-Resektats, welches ähnlich einem chirurgischen Präparat, eine sichere Aussage zur Entfernung der Veränderung im Gesunden ermöglicht und mit einer erheblichen Reduktion der lokalen Rezidivrate einhergeht [1].…”

“…1a -f) [1,2]. Wesentliche Vorteile gegenüber der Piecemeal-Schlingenresektion sind die Gewinnung eines ‚en bloc'-Resektats, welches ähnlich einem chirurgischen Präparat, eine sichere Aussage zur Entfernung der Veränderung im Gesunden ermöglicht und mit einer erheblichen Reduktion der lokalen Rezidivrate einhergeht [1]. Basierend auf unseren ganz persönlichen Erfahrungen an über 1000 Eingriffen seit dem Jahr 2000, soll dieser kleine Artikel Tipps geben zu Umfeldbedingungen, Logistik, Vorbereitung, Durchführung und Nachsorge bei der ESD [3 -9].…”