Underwater Duodenal ESD of a Large Adenoma Using the Pocket-Creation Method

Santos-Antunes, João; Morais, Rui; Marques, Margarida; Macedo, Guilherme

doi:10.1159/000512360

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…Because of the different conductive properties of water and saline, theoretically a bipolar device may be more adequate for immersion ESD, although some studies, including the largest ones, were successful using monopolar devices [24,[29][30][31]. The electrosurgical setting for the submucosal dissection phase varies between studies and includes the use of forced coagulation [24], endocut [30], and swift coagulation [31] modes.…”

Section: Underwater Esdmentioning

confidence: 99%

“…The advantages of underwater ESD are better visualization of the submucosal dissection plane, because of traction (from the buoyancy of the mucosal flap) and magnification of the underwater image, which can be useful in cases of fibrosis or increased submucosal fat tissue. While there are reports of successful underwater ESD in the esophagus [16], stomach [28], duodenum [29,30] and colon [19,31], there is only one comparative study that evaluated conventional ESD versus underwater ESD combined with PCM [24]. PCM plus underwater ESD was associated with shorter procedure time and higher dissection speed, with similar en bloc and adverse events rates.…”

Section: Underwater Esdmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

Libânio

Pimentel‐Nunes

Bastiaansen³

et al. 2023

Endoscopy

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ESGE suggests conventional endoscopic submucosal dissection (ESD; marking and mucosal incision followed by circumferential incision and stepwise submucosal dissection) for most esophageal and gastric lesions. ESGE suggests tunneling ESD for esophageal lesions involving more than two-thirds of the esophageal circumference. ESGE recommends the pocket-creation method for colorectal ESD, at least if traction devices are not used. The use of dedicated ESD knives with size adequate to the location/thickness of the gastrointestinal wall is recommended. It is suggested that isotonic saline or viscous solutions can be used for submucosal injection. ESGE recommends traction methods in esophageal and colorectal ESD and in selected gastric lesions. After gastric ESD, coagulation of visible vessels is recommended, and post-procedural high dose proton pump inhibitor (PPI) (or vonoprazan). ESGE recommends against routine closure of the ESD defect, except in duodenal ESD. ESGE recommends corticosteroids after resection of > 50 % of the esophageal circumference. The use of carbon dioxide when performing ESD is recommended. ESGE recommends against the performance of second-look endoscopy after ESD. ESGE recommends endoscopy/colonoscopy in the case of significant bleeding (hemodynamic instability, drop in hemoglobin > 2 g/dL, severe ongoing bleeding) to perform endoscopic hemostasis with thermal methods or clipping; hemostatic powders represent rescue therapies. ESGE recommends closure of immediate perforations with clips (through-the-scope or cap-mounted, depending on the size and shape of the perforation), as soon as possible but ideally after securing a good plane for further dissection.

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Section: Underwater Esdmentioning

confidence: 99%

Section: Underwater Esdmentioning

confidence: 99%

Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

Libânio

Pimentel‐Nunes

Bastiaansen³

et al. 2023

Endoscopy

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“…The duodenum remains a challenging location for endoscopic therapy and mucosal resection is the first-line endoscopic resection technique for non-malignant large DAs [ 38 , 39 ]. However, when EMR is not feasible and considering the risks associated with the surgical alternatives, endoscopic submucosal dissection can be considered by experienced endoscopists [ 39 , 40 ]. In our series, duodenal surveillance started later than recommended in international guidelines since a significant number of patients were referred to our clinic only in adult age after a CRC diagnosis in the patient or in a family member.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Approach to Duodenal Adenomas in Familial Adenomatous Polyposis: A Retrospective Cohort

Garcia¹,

Rosa²,

Silva³

et al. 2022

GE Port J Gastroenterol

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Introduction: Over 90% of the patients with familial adenomatous polyposis (FAP) will develop duodenal adenomas. Aim: The aim of this study was to evaluate the effectiveness and safety of endoscopic excision of large duodenal adenomas in FAP patients. Methods: All FAP patients from a familial risk clinic submitted to endoscopic therapy for duodenal adenomas ≥10 mm between January 2010 and February 2021 were included. Results: From 151 FAP families, 22 patients (50 lesions) were included: 54.5% female; median follow-up 8.5 (IQR: 5.8–12.3) years after the first endoscopy. First therapeutic endoscopy occurred at a median age of 41.0 years (IQR: 33.0–58.2). Repeat therapeutic endoscopy was required in 54.5% of patients. Median size of the largest adenoma was 15 mm (IQR: 10–18 mm); resection was piecemeal in 63.1% and en bloc in the remaining. In 2 cases, the resection was incomplete (fibrosis due to previous resection and difficult positioning). Complications occurred in 6.3% of the resected lesions (4 patients): 2 immediate (bleeding, perforation); 4 in the first week (1 bleeding, 2 mild pancreatitis, 1 perforation requiring surgery; the latter two after ampullectomy). Histology revealed low-grade dysplasia adenomas in 90.1%; no adenocarcinomas were found. One patient with Spigelman stage IV disease not amenable to endoscopic control underwent elective duodenopancreatectomy (without duodenal cancer). Conclusion: Endoscopic surveillance and treatment of duodenal adenomas in FAP patients was safe and effective in the prevention of duodenal cancer.

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Underwater Techniques in Gastrointestinal Endoscopy: Diving into the Depths

Sferrazza,

Calabrese,

Maselli

et al. 2024

Cancers

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The endoscopic resection of gastrointestinal tract lesions embraces different types of techniques, ranging from conventional polypectomy/endoscopic mucosal resection (EMR) to the field of third-space endoscopy, including endoscopic submucosal dissection (ESD), full-thickness resection and peroral endoscopic myotomy (POEM). Parallelly, the advent of underwater techniques has served as an add-on for both basic and advanced procedures, since its first report in 2012. We aimed to provide a comprehensive update on the state of the art about the feasibility of underwater basic and advanced techniques for GI endoscopy. Underwater EMR (U-EMR) has proved effective and safe in treating > 10 mm sessile or flat or all-size recurrent colonic lesions. Conversely, although data show good effectiveness and safety for <10 mm lesions, it is preferred when high-grade dysplasia is suspected, favouring cold snare polypectomy for all other cases. Moreover, promising data are emerging regarding the feasibility of U-ESD for difficult-to-resect colonic lesions. U-EMR represents a standard of care for treating < 25 mm superficial non-ampullary duodenal epithelial tumours. Data regarding oesophageal, gastric and ampullary lesions remains limited to small cohorts. Finally, using water immersion for POEM has shown a reduction in procedure time compared to the CO2 insufflation technique for vessel coagulation, albeit in a single-centre experience. Based on these results, U-EMR has become a standard for treating intermediate-size colonic and non-ampullary duodenal lesions, as highlighted also in the European Society of Gastrointestinal Endoscopy guidelines. Promising results have been shown in third-space endoscopy studies, even though further prospective studies are awaited to standardise the technique for both ESD and POEM.

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Underwater Duodenal ESD of a Large Adenoma Using the Pocket-Creation Method

Cited by 3 publications

References 7 publications

Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

Endoscopic Approach to Duodenal Adenomas in Familial Adenomatous Polyposis: A Retrospective Cohort

Underwater Techniques in Gastrointestinal Endoscopy: Diving into the Depths

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