Endoscopic submucosal dissection: the french touch

ESD was introduced relatively late in our country (2008) but the number of centers performing this technique is increasing. Our national society of digestive endoscopy has a national registry: between 2008 and 2014 the number of endoscopists doing ESD increased from 1% to 10 % and the number of procedures from 188 (2008-10) to 343 (2011-13). Results improved from 18% (2008-10) to 7.5% (2011-13) of perforations and 72.9% to 93 % of R0 resections. In France, the number of gastric lesions is too small to allow hands-on training and we usually perform our first cases in the rectum. As previously recommended by European experts, middle rectum is a relatively safe and easy site for beginners. In Lyon, we work on the development of a new water jet system called Nestis Enki II system, that allows high-pressure jet-injection of different solutions including viscous ones like hyaluronic acid. The bi-functional catheter is flexible and allows working in maximal retroflexed position without jet power loss. We reported an increased safety versus DualKnife in living pig colon using this waterjet with saline solution; recently, we showed the benefits of using this waterjet with hyaluronic acid to increase procedure speed. Results in humans are promising with 91.1% of R0 resections and 4.4 % of perforations in a retrospective multicenter experience.To summarize, the wave of ESD is now on Western Europe with more cases and better results. Some new devices are also developed in France nowadays.