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• W1582397515 endingPage "236" @default.
• W1582397515 startingPage "204" @default.
• W1582397515 abstract "Endoscopic mucosal resection (EMR) is an established technique for the treatment of nonelevated lesions using different techniques involving a snare for endoscopic resection. Larger areas of mucosa are usually removed in several parts in a so-called “piecemeal” technique. Endoscopic submucosal dissection (ESD) has been developed for the “en bloc” resection of early gastric cancer in Japan in order to allow a thorough histopathologic evaluation of the lateral as well as the vertical margins and is applied especially for lesions larger than 2 cm difficult to resect in one piece. EMR can be simple, e.g., for a 1.5 cm lesion in the rectum easily accessible or be very complex as in the duodenum or at the gastric cardia in inversion. It should therefore be considered as technique that needs learning and practice over years. One can start early with the first supervised steps of EMR. However, the student has to be safe in unsupervised gastroscopy and colonoscopy and should have basic skills in hemostasis techniques. ESD is currently a technique for the “high-end” endoscopist, requiring a long practice in interventional endoscopy and complication management. ESD originated in Japan and is a relatively new procedure in the Western world. The prerequisites and the learning curve to perform a “safe” and sufficiently expeditious ESD still have to be defined. ESD is a “freehand” needle-knife technique similar to needle-knife sphincterotomy when gaining access to the common bile duct in difficult ERCP situations. In the beginning, ESD is time-consuming and carries an increased complication risk especially perforation. Initial steps require access to a formal training program and expert teaching. Early training steps include a progressive approach to the technique in “ex vivo” pig stomachs. Training in live pigs is a useful next step to acquire ESD hemostasis skills and to train the technique in an environment with natural GI motility. For clinical practice, a close student–teacher relationship and sufficient phases of watching the procedure seem important before a student goes to unsupervised clinical ESD. Japanese say that at least 100 ESD procedures are required before the trainee reaches a sufficient speed and safety for standard “en bloc” resections. Systematic training programs will help to avoid pitfalls and lead to a successful spread of this undoubtedly fascinating technique." @default.
• W1582397515 created "2016-06-24" @default.
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• W1582397515 date "2011-04-26" @default.
• W1582397515 modified "2023-10-02" @default.
• W1582397515 title "Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection" @default.
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