John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive


Endoscopic submucosal dissection: Technical and strategic tips to progress! Volume 28, issue 2, Février 2021


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1 Hospices civils de Lyon, Hôpital Edouard Herriot, Service de gastro-entérologie et d’endoscopie, pavillon L, 5 place d’Arsonval, 69437 Lyon
2 CHU Pontchaillou, Service de gastroentérologie, Rennes
3 CHU Dupuytren, Service de gastroentérologie et d’endoscopie, Limoges
4 Clinique Claude Bernard, Gastroentérologie, Albi
* Correspondance

Endoscopic submucosal dissection is a fascinating technique which, regardless of the size of the lesion, when the procedure is successful, allows for “en bloc” resection with safety margins, known as R0 resection. This R0 quality level enables pathologists to analyse the specimen optimally and diagnose possible lympho-vascular invasion, budding or even to measure the exact depth of parietal invasion. However, while R0 brings an undeniable benefit for the patient, this benefit is not considered sufficient by many experts to accept the technical difficulties and the longer procedure time compared to fragmented mucosectomy. However, modern dissection with all the technical and strategic advances that have appeared in recent years no longer has much to do with the first procedures where the chosen strategy was, a posteriori, a source of difficulty. The aims of this review are to provide a number of technical and strategic tips to help you to save time and to get comfort during submucosal dissection procedures.