WEO Video: Dr. Yahagi
Dr. Yahagi from Toramon Hospital in Tokyo demonstrates the technique of endoscopic submucosal dissection for a gastric neoplasm
Dr. Yahagi from Toramon Hospital in Tokyo demonstrates the technique of endoscopic submucosal dissection for a gastric neoplasm. A special scope has been made for ESD which Dr. Yahagi demonstrates. The area is difficult to localize, but dye spray reveals the tumor. The area is marked with small coagulation points which act as limits of the tumor after submucosal injection has been accomplished. A viscous substance is injected into the submucosa in several areas, raising the tumor. A flex knife is used to incise the superficial mucosa down to the area of the submucosal fluid injection. A hood is attached to the endoscope to permit lifting up the tumor once submucosal resection has been accomplished. Bleeding is usually readily controlled with further application of the flex knife, however a small electrocautery forceps can also be used to precisely contact the bleeding site for coagulation. Once the tumor is incised circumferentially, further injections of fluid are made in the submucosal space to maintain a large fluid cushion and further submucosal dissection is carried out being careful to avoid the muscularis propria which is just deep to the fluid filled submucosa. Before completing the procedure, visible blood vessels in the submucosa are cauterized with electrocautery current to prevent late bleeding. An excellent submucosal excavation has been performed and the specimen is recovered in one large piece for histopathologic evaluation.
This was performed at the Prince of Wales Hospital during their annual therapeutic endoscopy course held in December 2009.
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