Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

Diogo Libânio; Pedro Pimentel-Nunes; Barbara Bastiaansen; Raf Bisschops; Michael J. Bourke; Pierre H. Deprez; Gianluca Esposito; Arnaud Lemmers; Philippe Leclercq; Roberta Maselli; Helmut Messmann; Oliver Pech; Mathieu Pioche; Michael Vieth; Bas L.A.M. Weusten; Lorenzo Fuccio; Pradeep Bhandari; Mario Dinis-Ribeiro

doi:10.1055/a-2031-0874

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Endoscopy 2023; 55(04): 361-389
DOI: 10.1055/a-2031-0874

Technical Review

Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

Diogo Libânio ‡

¹Department of Gastroenterology, Portuguese Oncology Institute – Porto, Portugal

²MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal

³Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal

,

Pedro Pimentel-Nunes ‡

⁴Department of Surgery and Physiology, Faculty of Medicine, University of Porto, FMUP, Porto, Portugal

⁵Gastroenterology, Unilabs, Portugal,

,

Barbara Bastiaansen

⁶Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands

,

Raf Bisschops

⁷Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium

,

Michael J. Bourke

⁸Department of Gastroenterology, Westmead Hospital, Sydney, Australia

⁹Western Clinical School, University of Sydney, Sydney, Australia

,

Pierre H. Deprez

¹⁰Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

,

Gianluca Esposito

¹¹Department of Surgical and Medical Sciences and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Italy

,

Arnaud Lemmers

¹²Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium

,

Philippe Leclercq

⁷Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium

,

Roberta Maselli

¹³Department of Biomedical Sciences, Humanitas University, Milan, Italy. Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy

,

Helmut Messmann

¹⁴Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany

,

Oliver Pech

¹⁵Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brueder Regensburg, Germany

,

Mathieu Pioche

¹⁶Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

,

Michael Vieth

¹⁷Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany

,

Bas L.A.M. Weusten

¹⁸Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands

¹⁹University Medical Center Utrecht, Utrecht University, The Netherlands

,

Lorenzo Fuccio

²⁰Department of Medical and Surgical Sciences, Gastroenterology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

,

Pradeep Bhandari

²¹Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK

,

Mario Dinis-Ribeiro

¹Department of Gastroenterology, Portuguese Oncology Institute – Porto, Portugal

²MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal

³Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal

› Author Affiliations

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Abstract

ESGE suggests conventional endoscopic submucosal dissection (ESD; marking and mucosal incision followed by circumferential incision and stepwise submucosal dissection) for most esophageal and gastric lesions. ESGE suggests tunneling ESD for esophageal lesions involving more than two-thirds of the esophageal circumference. ESGE recommends the pocket-creation method for colorectal ESD, at least if traction devices are not used. The use of dedicated ESD knives with size adequate to the location/thickness of the gastrointestinal wall is recommended. It is suggested that isotonic saline or viscous solutions can be used for submucosal injection. ESGE recommends traction methods in esophageal and colorectal ESD and in selected gastric lesions. After gastric ESD, coagulation of visible vessels is recommended, and post-procedural high dose proton pump inhibitor (PPI) (or vonoprazan). ESGE recommends against routine closure of the ESD defect, except in duodenal ESD. ESGE recommends corticosteroids after resection of > 50 % of the esophageal circumference. The use of carbon dioxide when performing ESD is recommended. ESGE recommends against the performance of second-look endoscopy after ESD. ESGE recommends endoscopy/colonoscopy in the case of significant bleeding (hemodynamic instability, drop in hemoglobin > 2 g/dL, severe ongoing bleeding) to perform endoscopic hemostasis with thermal methods or clipping; hemostatic powders represent rescue therapies. ESGE recommends closure of immediate perforations with clips (through-the-scope or cap-mounted, depending on the size and shape of the perforation), as soon as possible but ideally after securing a good plane for further dissection.

Tables 1 s–8 s

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Article published online:
07 March 2023

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Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

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