Post written by Hideaki Harada, MD, from the Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan.
This study prospectively evaluated the feasibility and safety of water-pocket ESD (WP-ESD), a new ESD method for superficial gastric neoplasms.
The ESD with gas insufflation method tends to distend the gut lumen and create fumes generated from diathermy, which can consequently limit the field of view during ESD. However, water immersion into the submucosal dissection area using saline solution could prevent such interference and result in a clear field of view and better traction. Therefore, it is very important to show the advantage, efficacy, and safety of WP-ESD.
Although some advantages of the conventional underwater technique have been reported, the technique requires filling the whole gut lumen with a larger volume of water (ranging from 500 to 5000 ml). On the contrary, our WP-ESD only needs a small volume of water (approximately 200 ml). Smaller water volumes decrease the risk of the outflow of saline solution into the peritoneal cavity when perforation occurs. Furthermore, the incidence of perforation using WP-ESD is less frequent because more precise adherence of a dissection line is possible via a clear field of view and better traction.
Figure 1. Methodologic schema of water-pocket endoscopic submucosal dissection (WP-ESD). The ESD procedure is carried out underneath the target lesion via a locally created WP in the submucosal layer.
We have shown that WP-ESD is an effective and safe approach for the dissection of the submucosal layer because it provides a clearer field of endoscopic view and better traction for the dissection in the submucosal layer than S-ESD. In afuture study, it is necessary to apply WP-ESD to colorectal neoplasms because we believe that this method is more suitable for a narrow GI tract such as the colon.
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