Insulated tip knife tunneling technique with clip line traction for safe endoscopic submucosal dissection of large circumferential esophageal cancer

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Presentation transcript:

Insulated tip knife tunneling technique with clip line traction for safe endoscopic submucosal dissection of large circumferential esophageal cancer Seiichiro Abe, MD, Ichiro Oda, MD, Haruhisa Suzuki, MD, Shigetaka Yoshinaga, MD, Yutaka Saito, MD VideoGIE DOI: 10.1016/j.vgie.2017.08.007 Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 Proximal side of the lesion; iodine staining revealed that this lesion involved the complete luminal circumference. VideoGIE DOI: (10.1016/j.vgie.2017.08.007) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 Distal side of the lesion; endoscopic submucosal dissection was performed in left lateral position while anesthesia was monitored. VideoGIE DOI: (10.1016/j.vgie.2017.08.007) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 Endoscopic submucosal dissection started with semicircumferential mucosal incision on the proximal side with use of both dual knife and insulated tip knife nano device. VideoGIE DOI: (10.1016/j.vgie.2017.08.007) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 4 A circumferential mucosal incision on the distal side to make an endpoint for submucosal dissection. VideoGIE DOI: (10.1016/j.vgie.2017.08.007) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 5 Insulated tip knife tunneling technique allowing communication between proximal and distal sides, with good traction against gravity to retract away from the area water pools. VideoGIE DOI: (10.1016/j.vgie.2017.08.007) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 6 Submucosal layer of the distal side was well visualized and lifted up with good traction by clip line traction technique. VideoGIE DOI: (10.1016/j.vgie.2017.08.007) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 7 Circumferential submucosal dissection completed, with no muscle injury. VideoGIE DOI: (10.1016/j.vgie.2017.08.007) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 8 Removal of syringe-shaped specimen. VideoGIE DOI: (10.1016/j.vgie.2017.08.007) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 9 The opened specimen revealed squamous cell carcinoma histologically, with deepest invasion to the lamina propria, negative margins, and measurement of 66 mm by 55 mm. VideoGIE DOI: (10.1016/j.vgie.2017.08.007) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions