The saline-immersion/irrigation technique (SITE) for endoscopic submucosal dissection (ESD) combined with protein-matrix gel facilitates vessel-management and avoids use of a coagulation-forceps

Abstract Text Another advantage of our saline immersion/irrigation technique (SITE) for ESD (which we first discovered in 2015 and published in 2017), is the highly effective pre-coagulation of vessels, obviating recourse to use of coagulation-forceps. This is best achieved through simultaneous irrigation of saline with concomitant knife-alone coagulation-diathermy. We have called the rapid, controlled whitening effect of the target vessel, ‘The Frozen Effect’ due to its resemblance to a white-frozen structure. For intra-ESD bleeding despite this, we first attempt haemostasis through knife-alone coagulation-diathermy. If unsuccessful, we avoid coagulation-forceps use through intraprocedural application of protein-matrix gel. The haemostatic effect is augmented through tamponade by tip-of-the-scope downward-pressure applied externally over the lesion-dissection flap; bleeding usually stops in about 5 minutes [1].

Video http://data.process.y-congress.com/ScientificProcess/Data//106/570/1428/fe9704bf-af0b-40d1-b6af-306ee83a213e/Uploads/16849_Coag_Free%20Final.mp4

Publication History

Article published online:
27 March 2025

• References

• 1 Despott EJ, Murino A.. Saline-immersion therapeutic endoscopy (SITE): An evolution of underwater endoscopic lesion resection. Dig Liver Dis 2017; 49 (12): 1376