Jejunal endoscopic submucosal dissection is feasible using the pocket-creation method and balloon-assisted endoscopy

摘要

An endoscope with a 3.2-mm working channel (EI-580BT; Fujifilm, Tokyo, Japan) and a small-caliber-tip transparent hood (ST hood; DH-15GR; Fujifilm) were used. The endoscope tip balloon was not attached because the lesion was located in the upper jejunum. The Hook knife (Olympus, Tokyo, Japan) was used for most of the dissection. The key feature of the PCM is entering and dissecting the submucosal layer to make a pocket using an ST hood after a minimal mucosal incision ([Fig. 2]). After creation of the submucosal pocket under the entire tumor, an additional mucosal incision was made and submucosal dissection performed. Use of the PCM for ESD with BAE safely achieved an en bloc resection of the tumor ([Video 1]). Fig. 2 An endoscopic image and schema of the pocket-creation method of endoscopic submucosal dissection for jejunal neoplastic lesions. a Endoscopic image in a submucosal pocket after creation of the submucosal pocket under the entire tumor. b Schema at the time the pocket was completed. Video 1 The pocket-creation method for endoscopic submucosal dissection of a jejunal adenoma. Georg Thieme Verlag. Please enable Java Script to watch the video.Download The PCM has four main advantages including: (i) maintaining a thick submucosal layer with a minimal incision; (ii) obtaining good traction by using an ST hood; (iii) conquering the vertical approach by adjusting the direction of the endoscope tip; and (iv) stabilizing the endoscope tip by synchronizing the endoscope and the pocket [1]. By using BAE, the overtube with a balloon prevents formation of a redundant loop, enabling accurate and stable operation without paradoxical movements ([Fig. 1]) [3].Endoscopy_UCTN_Code_TTT_1AP_2ADEndoscopy E-Videos https://eref.thieme.de/e-videos Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online.This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.