Post written by Marie Kurebayashi, MD, from the Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.
This video describes the collection method for duodenal specimens resected by endoscopic submucosal dissection (ESD). With this method, we leave a thin bundle of about 1 mm of submucosal fibers for the linkage of the resected specimen to the duodenal wall.
After grasping the dissected area of the lesion with large grasping forceps or a collecting net, the remaining bundle of fibers is easily sheared. We can collect the specimen safely with this method.
The advantage of en bloc excision in ESD is it allows precise pathological examination, so it is important to ensure that the resected specimen is always collected, but there is no report on the collection method.
Unlike other organs, in the case of the duodenum, the moment resection is completed, the resected specimen always flows toward the anal side under gravity. In such circumstances, there is a risk of losing the specimen. We think that this method ensures definitive specimen retrieval.
We consider the method we presented as safe, easy, and reliable to save the resected specimen. We hope this study will help reduce the loss of the resected specimen after duodenal ESD in daily clinical practice.
Collection method using large grasping forceps. A, A flat, elevated, 30-mm lesion located in the descending portion of the duodenum. B, A 1-mm width of submucosal fibers is left behind. C, The remaining bundle of fibers is bluntly sheared off with large grasping forceps. D, No tissue is left on the dissected ulcer floor. E, The lesion could be retrieved without any artificial damage.
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