Endoscopic submucosal dissection is an outpatient procedure to removes cancer from the gastrointestinal tract of a patient without removing the organ involved. The relative simplicity, safety and efficacy of EMR have made it an accepted alternative to surgical interventions such as esophagectomy.
However to ensure the curative potential of these treatment modalities, accurate histopathologic assessment of the resected specimens is essential because the depth of invasion and lymphovascular infiltration of the tumor is associated with considerable risk for lymph node metastasis.
These techniques are widely used in most of the countries. However its use in the West is limited.
Procedure of Endoscopic submucosal dissection
The Endoscopic submucosal dissection procedure is performed with an endoscope, a long, thin, flexible instrument about 1/2 inches in diameter. After undergoing Endoscopic submucosal dissection you will be given leaflets advising you about what to do if you need any help.
We also provide our personal mobile numbers in case of emergency. The procedure requires both a sophisticated knowledge for lesion characterization and high‐level endoscopic skills.
That your healthcare provider will use a flexible tube called an endoscope to see inside your esophagus, stomach, and small intestine and remove the tumors you have. The cancerous lesion is highlighted with a stain so that it stands out from the healthy tissue.
Although this approach deserves refinement, it has already led to the expansion of Endoscopic submucosal dissection has contributed to the widening of the indications for Endoscopic submucosal dissection, and has further developed Endoscopic submucosal dissection techniques.
Examination under a microscope can confirm whether the procedure completely removed the tumor. When the bleeding vessel is seen and endoscopic approach is possible, hemoclip or hemostatic forceps is useful.
If the vessel is hidden under blood clots and cannot be found, removal of clots and apply hemostasis to the correct point should be done. Remove the tissue from the body through the endoscope and send it to a laboratory.
Benefits of Endoscopic submucosal dissection
En bloc resection rates were significantly higher with endoscopic submucosal dissection than with conventional endoscopic mucosal resection, No significant differences were seen in complication rates between EMR and endoscopic submucosal dissection. Conventional EMR has predominantly been performed using strip biopsy, but local recurrence sometimes occurs due to such piecemeal resection.
Also, regardless of ulceration, the incidence of intraoperative bleeding was significantly higher with endoscopic submucosal dissection 22.6 percentage than with EMR 7.6 percentage. Delayed bleeding did not differ, in cases with ulceration.
The en bloc resection rate, histologically complete resection rate, operation time, complications, and local recurrence rate were studied in relation to ulceration.
However, rates were overwhelmingly better in the endoscopic submucosal dissection group than in the EMR group for lesions more than 5 mm in diameter, regardless of location.
Endoscopic submucosal dissection can take a long time, but is superior to conventional endoscopic mucosal resection for treating intramucosal gastric neoplasms. Endoscopic submucosal dissection can take a long time but is superior to conventional endoscopic mucosal resection for treating intramucosal gastric neoplasms. Special measures are necessary for endoscopic submucosal dissection of ulcerated lesions to reduce the rates of perforation and incomplete resection.
The risk of Endoscopic submucosal dissection
There are some risks having the Endoscopic submucosal dissection the following risks are commonly having peoples including,
Bleeding
The risk of bleeding in endoscopic submucosal dissection is from 13 percentages to 38 percentages which is slightly higher than EMR. Moreover, specimens resected in an en block fashion enable accurate histological assessment.
The post endoscopic submucosal dissection bleeding can be classified as immediate bleeding, early delayed bleeding, and late delayed bleeding according to the timing of bleeding. The bleeding rate of endoscopic mucosal resection has been reported as from 4 percentages to 38 percentages.
Inclusion criteria and exclusion criteria were defined in advance in this work. Be the most important technique in treatment of early gastrointestinal cancer or a premalignant lesion.
high-risks
The most important aspect of preventing perforation during endoscopic submucosal dissection is to have solid basic therapeutic endoscopic skills. It is important that accurate incision or submucosal dissection between the sub mucosa and muscularis propria layer is performed to prevent procedure related bleeding.
In addition high-risk cases for post endoscopic submucosal dissection bleeding, which include cases with the use of antithrombotic agents or which require large resection, are increasing bleeding diagnosed from 24 hours after the endoscopic submucosal dissection to when the second-look endoscopy was performed. To overcome these obstacles during performance of the procedure, we should be familiar with management of complications.
