Usefulness of sheath lifting after saline injection technique for colorectal endoscopic submucosal dissection

Incision Technique for Flattening the Elevated Mucosa due to Excess Local Injection During Colorectal Endoscopic Submucosal Dissection

“…Local submucosal injection with a long-lasting solution, such as glycerol or sodium hyaluronate, is crucial for colorectal endoscopic submucosal dissection (ESD). 1 – 3 However, local injection fluids in lesions with severe fibrosis or deep submucosal invasion tend to spread to the submucosal layer surrounding the tumor instead of being restricted to the tumor. 4 In such situations, the submucosal layer of the tumor is difficult to visualize and approach.…”

Endoscopic techniques for management of large colorectal polyps, strictures and leaks

“…Once the circumferential incision is completed, the lesion is then carefully dissected strand by strand after sequential submucosal injection, creating a mucosal flap underneath the lesion using coagulation current, being careful not to injure the underlying muscularis propria. Dissection is continued until the lesion is released from its submucosal attachment to eventually complete an en bloc resection [ [26] , [27] , [28] ] ( Image 7 ). Variations on technique include beginning with a mucosal injection distal to the lesion, followed by submucosal injection and tunnelling dissection underneath the lesion proceeding to the proximal extent, before completion of the resection after incising the lateral borders of the polyp.…”

Successful Creation of the Mucosal Flap in the Colorectal Endoscopic Submucosal Dissection Using a Push-Up, Grasp, and Cutting Technique

“…However, for lesions beyond the sigmoid colon with major respiratory changes, instability when creating the initial mucosal flap by using a tip-type knife was frequently experienced, despite the use of the lifting after saline injection technique. 5 This problem was overcome by using a CC when creating the initial mucosal flap. Resection could be safely performed even with respiratory changes because the lesion was tightly grasped by the CC.…”