Year: 2016
Type: article
Study design: Case Report
Abstract: Endoscopic submucosal dissection (ESD) allows en bloc resection of GI tumors regardless of lesion size or location. Extensive biopsies, partial endoscopic removal, and tattooing of these lesions are routinely performed in the United States, and these maneuvers lead to submucosal fibrosis, making subsequent ESD technically challenging. Countertraction is imperative in such cases. Two representative technically challenging ESD cases facilitated by countertraction methods are described here (Fig 1; Video 1, available at www.VideoGIE.org). The first gastric ESD was complicated by prior tattooing and incomplete resection, which caused significant submucosal fibrosis. In this case, a “suture-pulley” countertraction method was performed and allowed direct view of the submucosal dissection plane. The second colonic ESD case was complicated by previous tattooing and angulation, resulting in a perpendicular angle of the ESD knife to the muscle layer. A “rubber band traction” method was chosen in this case. This method uses a 5-mm nonlatex rubber band and a suture loop (3-0 monofilament suture) that can be delivered through the endoscope channel. Both of these countertraction methods facilitated successful ESD without perforation. Extensive biopsies, partial endoscopic removal, and tattooing directly into lesions should be avoided to limit submucosal fibrosis and minimize negative impact on future ESD procedures. Dr Aihara is a consultant for Olympus America. Dr Thompson is a consultant for Olympus America and Apollo Endosurgery. The other author disclosed no financial relationships relevant to this publication. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI0ODhmNTdmMWEyMTM0ZDNkOWJmNDI4MDFiNDk2MTA2ZSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjg4MTk4MzI4fQ.qq9k5AWRPlf3yrqPrGxBp-YV2j2XBl_V_7Q48XXP3XMt-TlCJY1GY-x2uUyfRzT_GbvPvD_bif2PZJECArpxjWaInpluJPMeNlK5bD6uK93AYvaA1Md-BKprgSS3mRgd2bLa8C_Oi3ItEZL2Ja-sKbTqdoO-jjt1k3PO8dxx5LVH-sF76Xhzn8Z-OLeThuvFtQQAn8tYziHqiyzkuhUnw2P8Nd49UVdoE1VB7edODUm6E3BOg1VjxV5fSWSroOmIF1Nb9zGpMNba_VVXJnQiSJrra16w3mzG3IAfU4C3rZTkx5hhqe8o-T8ZaNRD6uFcR1UwZDMLLHqmXTQvzjxfAw Download .mp4 (103.52 MB) Help with .mp4 files Video 1Countertraction methods in upper and lower endoscopic submucosal dissection. Download .docx (.02 MB) Help with docx files Video Script
Source: VideoGIE
Institution: Brigham and Women's Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,000
OpenAlex ID: W2529688230