Principles of Quality Controlled Endoscopic Submucosal Dissection with Appropriate Dissection Level and High Quality Resected Specimen.
- Author:
Takashi TOYONAGA
1
;
Eisei NISHINO
;
Mariko MAN-I
;
James E EAST
;
Takeshi AZUMA
Author Information
1. Department of Endoscopy, Kobe University Hospital, Kobe, Japan. toyonaga@med.kobe-u.ac.jp
- Publication Type:Review
- Keywords:
Endoscopic submucosal dissection;
Gastro intestinal neoplasms;
Quality control;
Dissection level;
Vessel network
- MeSH:
Fibrosis;
Lymph Nodes;
Muscles;
Neoplasm Metastasis;
Quality Control
- From:Clinical Endoscopy
2012;45(4):362-374
- CountryRepublic of Korea
- Language:English
-
Abstract:
Endoscopic submucosal dissection (ESD) has enabled en bloc resection of early stage gastrointestinal tumors with negligible risk of lymph node metastasis, regardless of tumor size, location, and shape. However, ESD is a relatively difficult technique compared with conventional endoscopic mucosal resection, requiring a longer procedure time and potentially causing more complications. For safe and reproducible procedure of ESD, the appropriate dissection of the ramified vascular network in the level of middle submucosal layer is required to reach the avascular stratum just above the muscle layer. The horizontal approach to maintain the appropriate depth for dissection beneath the vascular network enables treatment of difficult cases with large vessels and severe fibrosis. The most important aspect of ESD is the precise evaluation of curability. This approach can also secure the quality of the resected specimen with enough depth of the submucosal layer.
