TECHNICAL TIPS ON HOW TO HANDLE DIFFICULT CASES OF ESOPHAGEAL ENDOSCOPIC SUBMUCOSAL DISSECTION

Abstract

Endoscopic submucosal dissection (ESD) is the standard treatment for superficial esophageal cancer. Over the years, this intervention has evolved and has employed several tools, such as carbon dioxide insufflation and traction methods. However, there are still difficult case of ESD, such as cervical esophageal cancers, entire-circumferential lesions, lesions located close to scars, esophago-gastric junctional cancers, lesions located on the diverticula, and lesions on the esophageal varices. We hereby present some technical tips for such difficult cases. Since difficult cases could have a higher risk of adverse events, recovering the solution and surgical operation beforehand should be considered. We thereby recommend performing ESD for these lesions after gaining basic and advanced ESD knowledge and techniques.