ABSTRACT

Introduction: Endoscopic submucosal dissection (ESD) is a less invasive local treatment for early gastric cancer (EGC).

Areas covered: Japanese guidelines have recently expanded the endoscopic treatment indications for EGC. ESD is sometimes performed for lesions with a relative indication that has not previously been considered for ESD. ESD procedures are technically difficult, especially for larger and more invasive lesions. Complete resection and accurate histological assessment of EGC lesions are essential to evaluate endoscopic curability. Various endoscopic instruments, including three types of endoscopic knives and specific hemostatic forceps, have been developed, and endoscopic techniques, including the traction method, have been modified to simplify the procedure.

Expert opinion: An insulated-tip knife with large tissue contact allows us to perform faster incisions, while a needle-type knife with minimal tissue contact allows us to perform precise incisions. Furthermore, a scissor-type knife with grasping tissues allows us to perform more secure incision. The traction method enables the operator to proceed with submucosal dissection procedures. In cases with small lesions, snaring can be used, as well as knife dissection. Understanding the features of each endoscopic instrument and technique is essential because appropriate selection and usage contribute to successful and safe ESD procedures.

摘要

简介：内镜黏膜下剥离术 (ESD) 是早期胃癌 (EGC) 的一种侵入性较小的局部治疗方法。

涵盖的领域：日本指南最近扩大了 EGC 的内窥镜治疗适应症。ESD 有时用于具有以前未考虑进行 ESD 的相关适应症的病变。ESD 程序在技术上是困难的，特别是对于更大和更具侵袭性的病变。EGC 病变的完全切除和准确的组织学评估对于评估内镜可治愈性至关重要。已经开发了包括三种类型的内窥镜刀和特定止血钳在内的各种内窥镜器械，并且已经改进了包括牵引法在内的内窥镜技术以简化手术。

专家意见：组织接触面积大的绝缘尖端刀可以更快地进行切口，而组织接触最少的针型刀可以进行精确的切口。此外，带有抓握组织的剪刀式刀使我们能够进行更安全的切口。牵引方法使操作员能够进行黏膜下剥离程序。在病变较小的情况下，可以使用圈套​​器以及刀解剖。了解每种内窥镜器械和技术的特点至关重要，因为适当的选择和使用有助于成功和安全的 ESD 手术。