| International Session（Workshop）3(JGES・JSGE・JSGS) |
| Sat. November 2nd 9:00 - 12:00 Room 4: Portopia Hotel South Wing Portopia Hall |
| Lesson learned from Endoscopic Submucosal Dissection in a High Volume Center | |||
| Sergey V. Kantsevoy | |||
| Mercy Medical Center | |||
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| ESD was developed in Japan over 2 decades ago. Since that time numerous procedural modifications and special devices were introduced into the clinical practice. However, ESD continues to be a meticulous, labor-intensive, and time-consuming procedure requiring advanced endoscopic skills and a long and painfully slow learning curve. We performed over 1700 colonic interventions using double balloon interventional platform (DiLumen, Lumendi LLC) and recently published a randomized controlled study comparing traditional (T-ESD) with DiLumen-assisted colonic ESD. Mean procedure time decreased with DiLumen (88.6±42.7 min) vs. T-ESD (139.5±83.2 min), [51 minutes, 36.5%, p<0.001], with procedural savings of $610.16 (11.4%) per patient after DiLumen cost. DiLumen increased dissection speed by 49.0% (15.1±8.0 vs 7.7±6.6 cm2/hour, p<0.001). En bloc resection was superior with DiLumen (97.2% vs 87.0%, p=0.030). Mean navigation time with DiLumen for sutured defect closure decreased by 7.7 minutes (p<0.001). Future promising directions to simplify and to facilitate ESD: 1. Fuji TracMotion device. 2. Simplified C1 platform with a flexible grasper. 3. EndoCages. Conclusion: Double balloon interventional platform: 𝓁 Facilitates shortening and straightening of the colon during advancement of colonoscope 𝓁 Stabilizes endoscope, provides traction and markedly facilitates colonic ESD and EMR 𝓁 Creates conduit and simplifies endoscope's withdrawal, exchange and suturing closure of large mucosal defects post lesion removal 𝓁 Significantly shortens total procedure time. |
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Index Term 1: Endoscopic Submucosal Dissection Index Term 2: Gastrointestinal lesions |
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