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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 просмотров • 1 год назад •via X (Twitter)

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Комментарии: 8

Фото профиля ali mohmd
ali mohmd1 год назад

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

Фото профиля Flaubert Sena de Medeiros
Flaubert Sena de Medeiros1 год назад

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.

Фото профиля pedro bastos
pedro bastos1 год назад

cautery settings?

Фото профиля Marcio Paraboli
Marcio Paraboli1 год назад

@AdrianaPhalange Congrats Great Job👏👏👏

Фото профиля Syed Saad Ahmed
Syed Saad Ahmed1 год назад

Omg

Фото профиля د يوسف بن طواله
د يوسف بن طواله1 год назад

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

Фото профиля Romulo Freire
Romulo Freire1 год назад

O que você usou para injeção?

Фото профиля Flaubert Sena de Medeiros
Flaubert Sena de Medeiros1 год назад

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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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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