Post written by Daisuke Kikuchi, MD, PhD, from the Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.

During endoscopic procedures, it is a great advantage that the diameter of the endoscope is small. It is possible to enter a narrow space, and it is also possible to approach a lesion that cannot be approached by the conventional endoscope. In particular, it is a great advantage that endoscopic treatment beyond the stenosis after extensive esophageal ESD can be performed without balloon dilatation. In addition, the lesion on the posterior wall of the oropharynx can be approached horizontally by inserting transnasally. The horizontal approach to the target lesion makes ESD easier. Herein, we reported a case in which a lesion on the posterior wall of the oropharynx could be safely treated by transnasal ESD.

The ultra-thin endoscope has a small suction diameter, and its poor suction function is a big disadvantage. Also, the ultra-thin endoscope does not have a water jet function; hemostasis may be difficult when massive bleeding occurs. There are also restrictions on the clips that can be used when perforations occur during ESD. For safe ESD procedure, we endoscopists should always consider what to do in the event of an emergency. Because the devices that can be used with the ultra-thin endoscope are limited, we endoscopists have to know preoperatively the type of clips and hemostatic forceps that can be used with the ultra-thin endoscope.

The image quality of the ultra-thin endoscope has improved dramatically. The detection rate of superficial GI neoplasia in screening endoscopy is increasing, and recently is equivalent to conventional endoscopes. In the next stage, the ultra-thin endoscope will be used in the field of therapeutic endoscopy. For this purpose, designated devices such as hemostatic forceps, transparent hood, and ESD knife have been desired.

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