Endoscopic submucosal dissection with the Nestis® jet injector system with a bifunctional catheter: first prospective clinical trial (NCT: 2012-A00272-41)

Pioche, Mathieu; Lépilliez, Vincent; Ciocîrlan, Mihai; Rivory, Jérôme; Miaglia, Clothilde; Hervieu, Valérie; Poncet, Gilles; Valette, Pierre-Jean; Saurin, Jean‐Christophe; Ponchon, Thierry

doi:10.1007/s00464-016-4827-8

Cited by 3 publications

(3 citation statements)

References 14 publications

(23 reference statements)

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“…The result is better visualization of the plane and less fluid in the digestive cavity, which can interfere with the procedure. High-pressure strategies have shown their increased safety and effectiveness, particularly when combined with injection of macromolecule viscous solutions [70, 71]. Insulated tipThese knives are best used when pulling back (far to near side) or laterally.…”

Section: Endoscopic Submucosal Dissectionmentioning

confidence: 99%

“…The result is better visualization of the plane and less fluid in the digestive cavity, which can interfere with the procedure. High-pressure strategies have shown their increased safety and effectiveness, particularly when combined with injection of macromolecule viscous solutions[70,71].-Insulated tip• These knives are best used when pulling back (far to near side) or laterally. During ESD, IT knives generally anchor in the margin of the specimen,…”

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confidence: 99%

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Technical Advances in Endoscopic Resection Techniques for Lower GI Malignancies

Masgnaux,

Grimaldi,

Jacques

et al. 2024

Visc Med

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Background: The management of bulky neoplastic lesions in the digestive tract has historically been a surgical pursuit. With advancements in endoscopic techniques, particularly endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), a paradigm shift toward organ preservation has been initiated. These endoscopic methods, developed incrementally since the 1980s, have progressively enabled curative management of lesions with minimal morbidity, challenging the previously unchallenged domain of surgery. Summary: This review traces the evolution of endoscopic resection from snare polypectomy and EMR to sophisticated ESD, highlighting the technological innovations that have expanded the scope of endoscopic resection. It discusses the intricacies of various EMR techniques like underwater EMR, anchoring EMR, and hybrid EMR, alongside traction-assisted methods and the use of viscous solutions for submucosal injection. Additionally, the manuscript delves into the advancements in ESD, emphasizing traction strategies, knife technology, and the optimization of endoscopes. The benefits of these advancements are weighed against the challenges in anatomopathological interpretation posed by piecemeal resections. Key Messages: The continuous amelioration of endoscopic resection techniques has significantly improved the outcomes of digestive tract lesion management, particularly in achieving R0 resections and reducing recurrence rates. These advancements represent a monumental step toward minimizing the invasiveness of lesion management. However, despite the progress, the necessity for early follow-up post-EMR remains due to the non-negligible recurrence rates, underscoring the need for a rigorous postoperative surveillance regimen. Furthermore, our review suggests that while ESD has transformed the therapeutic landscape, its widespread adoption hinges on further simplification, safety enhancement, and acceleration of the procedure, possibly through innovations like adaptive traction devices.

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Section: Endoscopic Submucosal Dissectionmentioning

confidence: 99%

“…The result is better visualization of the plane and less fluid in the digestive cavity, which can interfere with the procedure. High-pressure strategies have shown their increased safety and effectiveness, particularly when combined with injection of macromolecule viscous solutions[70,71].-Insulated tip• These knives are best used when pulling back (far to near side) or laterally. During ESD, IT knives generally anchor in the margin of the specimen,…”

mentioning

confidence: 99%

Technical Advances in Endoscopic Resection Techniques for Lower GI Malignancies

Masgnaux,

Grimaldi,

Jacques

et al. 2024

Visc Med

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“…To obtain the first lift with the needle, it is necessary to prick deeply and to inject very gently by gradually withdrawing the needle until a bluish fish bladder bubble appears, reflecting a submucosal injection. Another option is possible, without a needle, with high-pressure knife injectors, such as the Hybrid Knife (Erbe, Tuebingen, Germany) or the Nestis Enki II (Nestis, Lyon, France), which allow the pressurized water jet to pass through the mucosa and fill the submucosa directly 8 9 .…”

Section: Submucosal Injectionmentioning

confidence: 99%

Endoscopic submucosal dissection: How to be more efficient?

et al. 2021

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Endoscopic submucosal dissection (ESD) allows an “en bloc” resection with safety margins (R0 resection) regardless of the size of the lesion. However, while R0 brings a real benefit for the patient, it is not considered sufficient by many experts to justify the technical difficulties and the longer procedure time compared to piecemeal mucosectomy. The aims of this review are to provide several technical and strategical tips to help you save time and become comfortable during ESD procedures. ESD is divided into several intertwined phases: injection, incision, access to the submucosae, and submucosal dissection itself. During injection there are some mistakes that should not be made: a superficial injection, or on the contrary, a too deep injection. A good needle and good injection technique are mandatory. Some techniques, such as repeated injection or prolonged lifting solution, can help maintain the lift. After this step, mucosal incision can be made, taking care to have a good margin to allow an R0 resection. Starting the mucosal incision from a small point allows calibration of the depth of the incision and then obtaining a nice incision. Trimming is also very important to widen submucosal access. Then comes the submucosal dissection itself. Strategies such as the tunnel strategy or the pocket creation method can help to facilitate dissection, but more importantly, traction systems have become unavoidable, especially in the stomach and colon. Most common complications are bleeding and perforation, and they usually can be managed endoscopically.

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