ESD IN THE COLON

DOI 20 References
  • YAMAMOTO Hironori
    Department of Internal Medicine, Division of Gastroenterology , Jichi Medical School
  • KITA Hiroto
    Department of Internal Medicine, Division of Gastroenterology , Jichi Medical School
  • SUNADA Keijiro
    Department of Internal Medicine, Division of Gastroenterology , Jichi Medical School
  • MIYATA Tomohiko
    Department of Internal Medicine, Division of Gastroenterology , Jichi Medical School
  • YANO Tomonori
    Department of Internal Medicine, Division of Gastroenterology , Jichi Medical School
  • IWAMOTO Michiko
    Department of Internal Medicine, Division of Gastroenterology , Jichi Medical School
  • OMATA Toshiaki
    Department of Internal Medicine, Division of Gastroenterology , Jichi Medical School
  • SHINHATA Hakuei
    Department of Internal Medicine, Division of Gastroenterology , Jichi Medical School
  • TONE Yukio
    Department of Internal Medicine, Division of Gastroenterology , Jichi Medical School
  • FUJIEDA Shinji
    Department of Internal Medicine, Division of Gastroenterology , Jichi Medical School
  • ABE Taro
    Department of Internal Medicine, Division of Gastroenterology , Jichi Medical School
  • IDO Kenichi
    Department of Internal Medicine, Division of Gastroenterology , Jichi Medical School
  • SUGANO Kentaro
    Department of Internal Medicine, Division of Gastroenterology , Jichi Medical School

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  • 大腸におけるＥＳＤ

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Abstract

When the feasibility of performing ESD in the colon is discussed, it is important to understand the difference of the features between the colon and stomach. When piecemeal EMR or ESD is chosen for the treatment of laterally spreading tumors in the colon, one should select one of the procedures by considering the risk/benefit ratio. In order to perform ESD safely in the colon, it is almost necessary to use sodium hyaluronate solution for the injection to create a submucosal cushion. Local injection of sodium hyaluronate can provide thickness and some stiffness to the thin and soft colonic wall. Safety margin for ESD is obtained from the long-lasting thickening created by the injection of sodium hyaluronate. For the mucosal incision and the submucosal dissection, electrosurgical knives suitable for front viewing approach should be selected. It is also useful to use a transparent hood attached to the endoscope tip to assist the incision and the dissection. A good strategy to maintain the submucosal thickening throughout the procedure and wise usage of gravity are also important factors for successful ESD. By selecting an appropriate technique, ESD can be performed safely even in the colon. Moreover, development and improvement of the instruments and techniques, ESD in the colon will become applicable more and more.

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