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Endoscopic Submucosal Dissection (ESD) for a 4 cm Sigmoid Polyp with High-Grade Dysplasia

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Flaubert Sena de Medeiros

1,350 subscribers

10,440 次观看 • 1 年前 •via X (Twitter)

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8 条评论

ali mohmd 的头像
ali mohmd1 年前

Is this a stalk? Who not using an endoloop followed by hot snaring??

Flaubert Sena de Medeiros 的头像
Flaubert Sena de Medeiros1 年前

For a polyp with a large cephalic portion and a narrow sigmoid, do not rely on opening the loop and the snare. However, this is just one tactic.

pedro bastos 的头像
pedro bastos1 年前

cautery settings?

Marcio Paraboli 的头像
Marcio Paraboli1 年前

@AdrianaPhalange Congrats Great Job👏👏👏

Syed Saad Ahmed 的头像
Syed Saad Ahmed1 年前

Omg

د يوسف بن طواله 的头像
د يوسف بن طواله1 年前

Hi . can you please send me a direct message . Thanks

Romulo Freire 的头像
Romulo Freire1 年前

O que você usou para injeção?

Flaubert Sena de Medeiros 的头像
Flaubert Sena de Medeiros1 年前

Salina com azul

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Cecal adenoma with high-grade dysplasia (HGD), resected en bloc by saline immersion ESD. #ESD #SalineImmersion #Endoscopy #ColorectalESD #TherapeuticEndoscopy
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Cecal adenoma with high-grade dysplasia (HGD), resected en bloc by saline immersion ESD. #ESD #SalineImmersion #Endoscopy #ColorectalESD #TherapeuticEndoscopy

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Ahmad Bazarbashi MD أحمد بازارباشي

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Zoom magnification use in endoscopy or ESD & POEM can be a game changer! enhancing visualization of submucosal vessels, defining perforating vessels from their origin to mucosal termination, and improving plane recognition during dissection. Combining this with low-force coagulation may allow effective vessel coagulation with less charring, reduced need for coagulation graspers, and better preservation of tissue planes and anatomy. Precision visualization with low forced controlled energy delivery can make dissection safer and more efficient. #ESD #POEM #Endoscopy #AdvancedEndoscopy ASGE GI Endoscopy ACG
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*Video and images shown with full, written informed consent from the patient. Our first ESD of 2024, performed last week, using our saline-immersion technique (SITE)-facilitated, tri-tunnel variation of the pocket-creation method (PCM). The lesion was a 12 x 9cm laterally spreading tumour involving the ileocaecal valve, caecum and ascending colon*. Dissection speed: 28.3 mm^2/min. SITE, which we first described in 2016, enhances patient comfort (avoiding the need for deep sedation), obviates the need for any traction (through buoyancy), enhances optical clarity (through elimination of dissection-related smoke, fat micelles, debris and through intrinsic magnification), and enhances visualisation of vessels and bleeding points. The use of saline (not water) is critical for conductivity. High-effect, forced coagulation enables very effective knife-alone management of vessels and any bleeding, and this, coupled with the use of self-assembling protein matrix gel (Purastat), obviates the need for the use of coagulation forceps. All these factors contribute to increased efficiency, effectiveness and patient comfort. Histopathology of the specimen confirmed complete (R0) resection and showed that the lesion consisted of a low grade dysplastic lesion without any evidence of invasive malignancy, confirming cure. ESD is an endoscopic microsurgical technique which affords an en bloc, organ-preserving, minimally invasive cure for such lesions, which unlike piecemeal resection, offers R0 with virtually no risk of recurrence; this latter point eliminates the need for tight surveillance and related patient inconvenience/risk, also reducing cost and environmental impact. Onwards and upwards for the betterment of minimally invasive care for all our patients!
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