Endoscopic Submucosal Dissection: A minimally invasive procedure used to remove precancerous or early-stage cancerous lesions from the gastrointestinal tract.
It involves separating the lesion from the underlying muscle layer using an endoscopic knife, allowing for en bloc resection and improved pathological assessment.
This technique offers higher rates of en bloc and complete resection compared to conventional endoscopic mucosal resection, enhancing the potential for curative treatment and reducing the risk of recurrence.
Effective Endoscopic Submucosal Dissection requires specialized training and equipment, as well as careful patient selection to optimize outcomes.
Most cited protocols related to «Endoscopic Submucosal Dissection»
This study was conducted as a retrospective image analysis study. Patients who were examined using the LASEREO system (FujiFilm Corporation) before they underwent endoscopic submucosal dissection (ESD) at Okayama University Hospital (Okayama City, Japan) and Tsuyama Chuo Hospital (Tsuyama, Japan) from October 2014 to January 2016 were included in this study. The ethical review boards of Okayama University Hospital and Tsuyama Chuo Hospital approved this retrospective chart review and analysis of the procedural data used in this study.
Kanzaki H., Takenaka R., Kawahara Y., Kawai D., Obayashi Y., Baba Y., Sakae H., Gotoda T., Kono Y., Miura K., Iwamuro M., Kawano S., Tanaka T, & Okada H. (2017). Linked color imaging (LCI), a novel image-enhanced endoscopy technology, emphasizes the color of early gastric cancer. Endoscopy International Open, 5(10), E1005-E1013.
Among gastric cancers that had been treated by endoscopic submucosal dissection (ESD) in our hospital, the following were selected on the basis of their appearance revealed by magnifying endoscopic imaging with NBI performed beforehand: 10 lesions showing a distinct white zone (Figure 5(a)), 10 lesions without any visible white zone (Figure 5(b)), and 10 lesions with a visible but nondistinct white zone (Figure 5(c)). In all cases, it had been confirmed that the histological areas examined corresponded to the parts observed by NBI-magnifying endoscopy. The resected specimens were examined using an Olympus BX50 microscope, and the lengths of the intervening parts of each type of cancerous mucosa in all 30 lesions were measured using a microscopic scale. Photographs of histological specimens were also taken using a Nikon DS L-1. The lengths of three intervening parts were measured in each lesion (Figures 6(a), 6(b), and 6(c)). Furthermore, the lengths of the intervening parts in the surrounding gastric mucosa, which exhibited gastritis, were also measured in all 30 lesions. White zones were clearly observed in all of the surrounding mucosal areas examined. The internal part of each intervening part between the crypts had a profile resembling an ellipse (Figure 6(a), area outlined by yellow dots), and this allowed the major axis (Figure 6(a), yellow line) of the ellipse to be drawn. The widest part vertical to the major axis less than 100 μm from the top of the intervening parts was adopted as the length (Figures 6(a), 6(b), and 6(c), bold yellow line with arrow on both sides). Representative intervening parts showing the histological features of each type of area were chosen from one microscopic field beforehand and also as a rough measure.
Yagi K., Nozawa Y., Endou S, & Nakamura A. (2012). Diagnosis of Early Gastric Cancer by Magnifying Endoscopy with NBI from Viewpoint of Histological Imaging: Mucosal Patterning in terms of White Zone Visibility and Its Relationship to Histology. Diagnostic and Therapeutic Endoscopy, 2012, 954809.
By conducting retrospective chart review, we recognized a total of 127 patients having 133 suspected or established rectal NETs were referred for endoscopic treatment from July 2015 to May 2020. Abdominopelvic computed tomography was performed for newly diagnosed rectal NET cases. Anorectal endoscopic ultrasonography (EUS) was selectively performed to determine whether the NET was confined to the submucosal layer or not in patients with NET > 10 mm in size or NET with depressed or ulcerated surface. A patient who had a rectal NET with suspected proper muscle invasion on EUS underwent a low anterior resection. Endoscopic resection was performed for the remaining 132 lesions in 126 patients by a single endoscopist (D.H.Y.) who had expertise in EMR, EMR-P, EMR-C, and ESD13 ,14 (link). EMR-C was mainly conducted before March 2019, and ASEMR was conducted thereafter because of the reimbursement issue. ASEMR was attempted for 45 lesions, and EMR-C was performed on 41 lesions (Fig. 1). As conventional EMR (n = 7) and EMR-P (n = 13) were performed in only a limited number of cases, ASEMR was not compared with these resection methods. As ESD (n = 26) was performed for NETs larger than 10 mm or those having a surface depression or ulceration, ASEMR and ESD were also not compared.
Flow chart of patient throughput. NET neuroendocrine tumor, EMR endoscopic mucosal resection, EMR-P EMR with circumferential precutting, ESD endoscopic submucosal dissection, ASEMR anchored snare-tip EMR, EMR-C cap-assisted EMR.
Kim J., Kim J., Oh E.H., Ham N.S., Hwang S.W., Park S.H., Ye B.D., Byeon J.S., Myung S.J., Yang S.K., Hong S.M, & Yang D.H. (2021). Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors. Scientific Reports, 11, 12918.
Consecutive patients who were found to have any type of gastric neoplasm during upper gastrointestinal endoscopy between 2010 and 2017 at Chuncheon Sacred Heart Hospital were enrolled. The aim of endoscopic examinations and detailed procedures are described in our previous report [19 (link)]. All the neoplasm-suspected lesions that were resected using either the endoscopic resection (endoscopic mucosal resection or endoscopic submucosal dissection technique (ESD)) or surgical resection were included. Pathological assessment of each lesion was carried out by two pathologists. Samples defined as tumors were cross-checked by yet another pathologist in the Chuncheon Sacred Heart hospital [19 (link)]. White-light imaging (WLI) endoscopy data from gastric lesions with pathological confirmation were retrieved from the database of Chuncheon Sacred Heart hospital in JPEG format, with a minimum resolution of 640 × 480 pixels. Images with poor quality or low resolution disabling their proper classification (defocusing, artifacts, shadowing, etc.) were excluded, as previously described [19 (link)]. Eventually, a total of 2899 images from 846 patients were included in the study. This study was approved by the Institutional Review Board of Chuncheon Sacred Heart Hospital (number: 2018-07-003), and was conducted in accordance with the Declaration of Helsinki. IRB approval number: 2018-07-003.
Cho B.J., Bang C.S., Lee J.J., Seo C.W, & Kim J.H. (2020). Prediction of Submucosal Invasion for Gastric Neoplasms in Endoscopic Images Using Deep-Learning. Journal of Clinical Medicine, 9(6), 1858.
All patients will receive localization and surgery within 1 week after randomization. Endoscopic tattooing with autologous blood and intraoperative colonoscopy will be performed by two experienced endoscopists who has more than thousands of cases colonoscopies and more than 200 cases of endoscopic mucosal resection or endoscopic submucosal dissection. For patients who will enroll in autologous blood group, the tattooing will be performed at 24–48 hours before the surgery. When the lesion is identified by endoscopy, the patient’s peripheral venous blood will be collected using a 10 ml simple syringe without heparin preparation. Immediately after blood sampling, 2–3 ml of autologous blood will be injected submucosally at the distal side and proximal side of the lesion (about 2 cm below and above the border of the lesion) using a conventional endoscopic needle without submucosal injection of normal saline. The tattooing with autologous blood will consider to be invisible if both distal and proximal spots was not identified. For those receiving autologous blood localization, the case will be applied intraoperative colonoscopy if the autologous blood tattoo will not be identified or inaccurate in the laparoscopic colectomy. For patients who will enroll in intraoperative colonoscopy group, the patient will be placed in the modified lithotomy position under general anesthesia with endotracheal intubation. The legs will be opened and positioned in padded stirrups to facilitate the insertion and manipulation of the colonoscope during the operation. After routine laparoscopic exploration, CO2-insufflated intraoperative colonoscopy will be performed using a flexible videocolonoscope. Upstream small bowel clamping will be applied before intraoperative colonoscopy. During intraoperative colonoscopy, CO2 pneumoperitoneum will be maintained by the insufflator so that the laparoscope could guide the colonoscope effectively. After lesion will be identified, a standard laparoscopic colectomy will be performed by two experienced surgeons who has more than 20 years of experience in colorectal surgery with more than 200 cases per year for all enrolled patients. All abdominal operation of laparoscopy will be videotaped. Anastomosis will be performed using the instrumental method. The specimen will be pulled out through a small median incision under the xiphoid (about 3–8 cm). For those receiving laparoscopic colectomy, the case will be required to be converted to open surgery if one of the following happens: severe or life-threatening intraoperative complications such as intra-abdominal massive haemorrhage, severe organ damage, or other technical or instrumental factors that require a conversion to open surgery.
Zhang K.H., Li J.Z., Zhang H.B., Hu R.H., Cui X.M., Du T., Zheng L., Zhang S., Song C., Xu M.D, & Jiang X.H. (2023). Assessment of Autologous Blood marker localIzation and intraoperative coLonoscopy localIzation in laparoscopic colorecTal cancer surgery (ABILITY): a randomized controlled trial. BMC Cancer, 23, 204.
This retrospective, single-center, observational study evaluated the procedure-related outcomes between CWL-ESD and SLC-ESD for superficial gastric neoplasms. Figure 3 shows the patients’ enrollment process. We enrolled that the consecutive cases of gastric ESD performed at the Department of Endoscopy, Shonan Fujisawa Tokushukai Hospital (Fujisawa, Kanagawa, Japan) from November 2017 (introduction of SLC for gastric ESD at our hospital) to September 2020. During this period, 191 patients with 196 superficial gastric neoplasms (early gastric cancer or gastric adenoma) underwent ESD by a single endoscopist (M.N.), who had the experience of > 500 ESD procedures, including > 30 CWL-ESD procedures at the beginning of the study period. Of these, the following were excluded: lesions resected by conventional ESD (n = 44); lesions of the remnant stomach after gastrectomy because the ESD procedure in the remnant stomach is more difficult than in the stomach without gastrectomy (n = 4) [16 (link)]; in cases that underwent gastric ESD for ≥ 2 gastric lesions on the same day, only the first lesion was included, and other lesions were excluded (n = 5); and lesions suspected of superficial gastric neoplasms preoperatively but diagnosed as non-neoplastic lesions pathologically after ESD (n = 3). Finally, 140 lesions from 140 patients who underwent CWL-ESD or SLC-ESD were extracted. Based on the treatment approach adopted, all patients were categorized into two groups—CWL-ESD group (n = 42) and SLC-ESD group (n = 98).
Flowchart of the study sample. SGN, superficial gastric neoplasm; ESD, endoscopic submucosal dissection; CWL-ESD, clip with line-assisted endoscopic submucosal dissection; SLC-ESD; spring and loop with clip-assisted endoscopic submucosal dissection
Nagata M., Namiki M., Fujikawa T, & Munakata H. (2023). Impact of Traction Direction in Traction-Assisted Gastric Endoscopic Submucosal Dissection (with Videos). Digestive Diseases and Sciences, 68(6), 2531-2544.
The CWL-ESD procedure did not include the traction method other than CWL-ESD, underwater techniques [25 (link)–27 (link)], the pocket creation method [28 (link)], the endoscopic submucosal tunnel dissection method [29 (link)], or any other special technique. The endoscope was withdrawn after a circumferential mucosal incision. The clip applicator was inserted into the accessory channel of the endoscope. The CWL, the clip (HX-610-090; Olympus) with a commercially available waxed nylon dental floss tied to its arm, was attached to the clip applicator (Fig. 5A). Then, the endoscope was reinserted through the overtube, and the CWL was attached to the oral or anal edge of the lesion (Fig. 5B). These steps ensured that the line came out of the mouth without passing through the accessory channel of the endoscope, while avoiding the interference between the devices positioned from the accessory channel and the line. Finally, pulling the line provided per-oral traction (Fig. 5C). To sustain the traction force, a sinker (~ 10 g) was attached to the line. After resection, the specimen with the CWL was extracted from the body.
The procedure of clip with line-assisted endoscopic submucosal dissection (CWL-ESD). A The CWL was attached to the clip applicator. B The CWL was attached to the edge of the lesion. C Pulling the line from outside the body provided a good field of vision and sufficient tension for the dissection plane
Nagata M., Namiki M., Fujikawa T, & Munakata H. (2023). Impact of Traction Direction in Traction-Assisted Gastric Endoscopic Submucosal Dissection (with Videos). Digestive Diseases and Sciences, 68(6), 2531-2544.
All procedures not specific to the SLC were performed as described in the CWL-ESD procedure. If both the forward and retroflexed endoscopic positions had similar degrees of difficulty performing submucosal dissection, the forward endoscopic position was prioritized, as it was less likely to cause interference between the endoscope and the spring (Figs. 6A). First, the SLC was attached to the oral or anal edge of the lesion after a circumferential mucosal incision (Fig. 6B). Second, the regular clip captured the loop part of the SLC and then anchored it to the gastric wall (Fig. 6C). Finally, the spring extension provided traction for the lesion, providing a good field of vision and adequate tension for the dissection plane (Fig. 6D). A noteworthy advantage of the SLC is that its traction direction can be controlled in any direction by the anchor site. We set traction vertical to the gastric wall (vertical traction) as much as possible, using the multidirectional traction function of the SLC. Contrary to the CWL-ESD procedure, SLC and anchor clip could be delivered to the stomach through the accessory channel of the endoscope without the endoscope withdrawal during SLC attachment. For the SLC-ESD procedure, a modified attachment method was used to streamline the attachment procedure and avoid interference between the endoscope and the spring part of the SLC [15 (link), 30 (link), 31 (link)]. After resection, the anchor clip was removed from the gastric wall with forceps, and the specimen, SLC, and anchor clip were extracted from the body.
Spring and loop with clip (SLC; S–O clip; Zeon Medical, Tokyo, Japan)-assisted endoscopic submucosal dissection (SLC-ESD). A Interference between the endoscope and spring part of the SLC during submucosal dissection rarely occurs. B After circumferential mucosal incision, the SLC is delivered via the accessory channel of the endoscope and attached to the lesion; C the regular clip captures the loop part of the SLC and then anchors it on the gastric wall; D the traction provides a good field of vision and sufficient tension for the dissection plane (Nagata [31 (link)])
Nagata M., Namiki M., Fujikawa T, & Munakata H. (2023). Impact of Traction Direction in Traction-Assisted Gastric Endoscopic Submucosal Dissection (with Videos). Digestive Diseases and Sciences, 68(6), 2531-2544.
Endoscopic submucosal dissection (ESD) is the most common treatment option for gastrointestinal neoplasm, including EGC.22, 23 ESD was performed in patients with absolute indications, including intramucosal differentiated‐type adenocarcinoma measuring <2 cm without ulceration, and also in those with expanded indications. The expanded indications included (i) mucosal cancer without ulcer findings, irrespective of tumor size; (ii) mucosal cancer with an ulcer ≤3 cm in diameter; and (iii) minimal (≤500 μm from the muscularis mucosa) submucosal invasive cancer ≤3 cm in size.24, 25 The shape and margin of these lesions were determined, and the endoscopic procedures were performed using a single‐channel endoscope (GIF H260; Olympus, Tokyo, Japan). Using argon plasma coagulation, the lesion boundary was marked with dotted lines. Isotonic saline with dilute epinephrine (1:10 000) was then injected into the submucosal layer to elevate the lesion. For ESD, a circumferential incision was made around the lesion, which was dissected using an insulated tipped knife (or dual knife; Olympus). For sedation, 3–5 mg of midazolam was administered intravenously. All patients were monitored for cardiopulmonary functions.
Kim Y.H., Jung Y.M., Park T.Y., Jeong S.J., Kim T.H., Lee J., Park J., Kim T.O, & Park Y.E. (2023). Comparisons of pathologic findings and outcomes of gastric cancer patients younger and older than 40: a propensity score matching study in a single center of Korea. JGH Open: An Open Access Journal of Gastroenterology and Hepatology, 7(2), 118-127.
The DualKnife is a versatile lab equipment designed for precise tissue dissection and sample preparation. It features two independently controlled blades that can operate simultaneously, enabling efficient and controlled cutting of various sample types. The core function of the DualKnife is to provide users with a precise and customizable tool for their laboratory workflows.
The GIF-H260Z is a versatile laboratory equipment designed for a range of scientific applications. It features a high-resolution optical system and advanced imaging capabilities to support detailed analysis and observation tasks. The core function of the GIF-H260Z is to provide users with a reliable and precise tool for their research and testing needs.
The Flush Knife is a precision instrument used for cutting and trimming various materials. It features a sharp, angled blade that is designed to provide a clean, flush cut along edges and surfaces. The Flush Knife is a versatile tool suitable for a range of applications, including in laboratory and industrial settings.
The GIF-Q260J is a laboratory equipment product from Olympus. It is designed to perform a core function, but the specific details of its intended use are not available in this concise, unbiased, and factual description.
The GIF-H260 is a high-performance laboratory equipment designed for general-purpose applications. It features a compact and durable construction, offering reliable performance. The device's core function is to provide a stable and controlled environment for various laboratory procedures.
The GIF-Q260 is a high-precision laboratory equipment designed for advanced imaging and analysis applications. It features a state-of-the-art imaging sensor and advanced optical components to provide detailed, high-resolution images. The core function of the GIF-Q260 is to capture and process visual data for scientific and research purposes.
The KD-650L is a laboratory centrifuge designed for general-purpose applications. It features a maximum speed of 6,500 rpm and a maximum RCF of 5,250 x g. The centrifuge has a rotor capacity of 6 x 50 mL tubes or 24 x 1.5/2.0 mL tubes. The unit is equipped with a brushless DC motor and an electronic control system.
The VIO300D is a high-performance electrosurgical generator. It is designed for use in a variety of surgical procedures, providing precise control and consistent cutting and coagulation performance.
The Hook Knife is a specialized lab equipment tool designed for precise cutting and dissection tasks. It features a curved, hook-shaped blade that allows for controlled and targeted cuts. The core function of the Hook Knife is to facilitate accurate and delicate tissue separation and manipulation in various laboratory applications.
The CF-H260AL is a compact and durable optical microscope designed for laboratory and educational settings. It features a professional-grade optical system with high-resolution magnification capabilities. The microscope is equipped with a sturdy metal frame and a comfortable binocular viewing head, allowing for precise observation and analysis of samples.
Endoscopic Submucosal Dissection (ESD) offers several advantages over conventional endoscopic mucosal resection (EMR). ESD allows for en bloc resection of lesions, meaning the entire lesion is removed in one piece. This improves the pathological assessment and increases the chance of curative treatment, as it reduces the risk of piecemeal resection and potential recurrence. Additionally, ESD has higher rates of complete resection compared to EMR, further enhancing the potential for curative outcomes.
Careful patient selection is crucial for optimizing outcomes with Endoscopic Submucosal Dissection (ESD). Factors to consider include the size, location, and characteristics of the lesion, as well as the patient's overall health and risk factors. Lesions that are larger, have a high risk of lymph node metastasis, or are located in challenging anatomical areas may require a more thorough evaluation to determine the suitability for ESD. Trained endoscopists should carefully assess each case to ensure the procedure is appropriate and can be performed safely.
PubCompare.ai's AI-powered platform can be immensely helpful in optimizing Endoscopic Submucosal Dissection (ESD) research protocols. The platform allows you to efficiently screen protocol literature from a wide range of sources, including publications, preprints, and patents. Its AI-driven analysis can pinoint critical insights that help you identify the most effective ESD protocols for your specific research goals. By leveraging the platform's comparative capabilities, you can easily compare different ESD protocols and choose the best option to ensure reproducibility and accuracy in your research.
Endoscopic Submucosal Dissection (ESD) is a technically demanding procedure that requires specialized training and equipment. Some of the common challenges and complications include perforation, bleeding, and incomplete resection. PubCompare.ai's AI-powered platform can assist researchers in addressing these challenges by helping them identify the most effective ESD protocols from the literature. The platform's comparative analysis can highlight key differences in protocol effectiveness, procedure techniques, and complication rates, allowing researchers to choose the optimal approach for their specific needs and minimize the risk of complications.
Endoscopic Submucosal Dissection (ESD) has evolved over time, and there are now several variations or types of the procedure. These include gastric ESD, colorectal ESD, and esophageal ESD, each with its own unique challenges and considerations. PubCompare.ai's AI-powered platform can be invaluable in helping researchers compare these different ESD variations. The platform can quickly sift through the literature to identify protocols for each type of ESD, and its comparative analysis can reveal the key differences in technique, success rates, and complication profiles. This allows researchers to make informed decisions on the most appropriate ESD approach for their specific research objectives and patient population.
More about "Endoscopic Submucosal Dissection"
Endoscopic Submucosal Dissection (ESD) is a minimally invasive procedure used to remove precancerous or early-stage cancerous lesions from the gastrointestinal tract.
This advanced endoscopic technique involves separating the lesion from the underlying muscle layer using specialized endoscopic knives, such as the DualKnife, GIF-H260Z, Flush Knife, GIF-Q260J, GIF-H260, GIF-Q260, KD-650L, and Hook knife, allowing for en bloc resection and improved pathological assessment.
Compared to conventional Endoscopic Mucosal Resection (EMR), ESD offers higher rates of en bloc and complete resection, enhancing the potential for curative treatment and reducing the risk of recurrence.
ESD requires specialized training and equipment, as well as careful patient selection to optimize outcomes.
The VIO300D electrosurgical unit is often used in conjunction with these endoscopic tools to facilitate the ESD procedure.
The benefits of ESD include the ability to precisely remove lesions while preserving the surrounding healthy tissue, leading to better long-term outcomes for patients.
This technique is particularly useful for the management of early-stage gastrointestinal cancers, such as those found in the esophagus, stomach, and colorectum.
With advancements in endoscopic technology and techniques, ESD has become an increasingly important option for minimally invasive cancer treatment.
