Endoscopic submucosal dissection

Endoscopic submucosal dissection is a relatively common gastric treatment method and is usually performed in the gastrointestinal surgery department. Before treatment, we should pay attention to diet. Do not eat too spicy food within one week before the operation and pay attention to a light diet. This will have a good buffering effect on the operation, avoid more disease damage, and ensure rapid recovery from the disease. So, what is endoscopic submucosal dissection?

1. Case selection

ESD is mainly used to treat patients with precancerous lesions and early cancer. In the cases we selected, the pathological findings of lesions located in the upper gastrointestinal tract were varied, ranging from severe atypical hyperplasia to carcinoma. The lesions located in the colorectum were mainly laterally developing tumors and early cancers, and the diameter of the lesions was more than 1.5 cm. Patients should undergo endoscopic ultrasound examination before surgery to determine whether the lesion is located in the mucosal layer or submucosal layer, and a complete submucosal boundary should be seen between the lesion and the muscular layer.

2. Preoperative Preparation

All patients were admitted to the hospital for treatment and given routine blood tests, biochemical tests and blood type tests. ESD could only be performed if the bleeding and coagulation times of the patients were normal. Before the operation, the patient was informed of the risks of ESD and his/her consent was obtained and signed. For patients whose lesions are located in the upper gastrointestinal tract, painless anesthesia is routinely performed, and endotracheal intubation is performed on some patients. For patients whose lesions are located in the rectum or sigmoid colon, the operation can be performed while they are awake.

3. Use of Equipment

Olympus endoscope, high-frequency electric generator, needle incision knife, insulated end scalpel (IT knife), triangular end scalpel (TT knife), snare, thermal biopsy forceps, etc.

4. Surgical Method

After the lesion is located by endoscopy, staining is performed first. If the lesion is located in the esophagus, iodine staining is performed; if it is located in the cardia area, double staining of iodine and methylene blue is performed; if it is located in the stomach or rectum, methylene blue or 0.1%~0.4% indigo carmine staining is performed. Microprobe endoscopic ultrasound (EUS) was used to confirm that the lesion was located in the mucosal layer. When the lesion is located in the mucosal layer, a glycerol-fructose solution containing methylene blue is injected under the lesion mucosa, and then a needle-type incision knife is used to mark the excision boundary. Use a needle knife to open the hole, and use an IT knife to cut and peel. If bleeding occurs during the operation, use IT knife, TT knife or hot biopsy forceps for electrocoagulation to stop bleeding. If bleeding does not stop, use hemostatic clips to stop bleeding. The lesion should be removed as completely as possible (Figure 4). If removal is difficult, a snare can be used to assist in electrocautery. After surgery, the specimens were fixed and sent directly to the pathology department for pathological examination.