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Shichijo et al. Mini-invasive Surg 2022;6:19 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.121

Review Open Access

Devices, techniques, traction, suturing, and

countermeasures for endoscopic submucosal
dissection complications

Satoki Shichijo, Yoji Takeuchi

Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka 541-8567, Japan.
Correspondence to: Yoji Takeuchi, Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69,
Otemae, Chuo-ku, Osaka, 541-8567, Japan. E-mail: yoji.endoscopy@oici.jp
How to cite this article: Shichijo S, Takeuchi Y. Devices, techniques, traction, suturing, and countermeasures for endoscopic
submucosal dissection complications. Mini-invasive Surg 2022;6:19. https://dx.doi.org/10.20517/2574-1225.2021.121
Received: 29 Oct 2021 First Decision: 26 Jan 2022 Revised: 9 Feb 2022 Accepted: 25 Feb 2022 Published: 22 Apr 2022

Academic Editors: Giulio Belli, Simon Ng Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Endoscopic submucosal dissection (ESD) is widely performed to treat superficial colorectal tumors because it
enables en bloc resection of various types of lesions. However, ESD sometimes leads to deleterious adverse events,
such as perforation and delayed bleeding. Therefore, determining the precise preoperative indication for ESD is
vitally important. Furthermore, small lesions with fibrosis and semi-large lesions can be managed using underwater
endoscopic mucosal resection, and the “true” indication for ESD is for the treatment of larger lesions, for which ESD
carries a higher risk. Here, we reviewed the devices, techniques (i.e., pocket creation method, water pressure
method, and clip and flap method), traction (i.e., clip with line, pulley method, and clip with ring), suturing (i.e., line-
assisted complete closure, loop clip, clip-on-clip closure method, mucosal incision around the mucosal defect, and
hand-suturing), and countermeasures to address complications (i.e., bleeding after ESD, perforation, and post-ESD
coagulation syndrome) that facilitate easier and safer ESD.

Keywords: Colorectal tumors, endoscopic submucosal dissection, traction, suturing, pocket creation

INTRODUCTION
Endoscopic submucosal dissection (ESD) leads to en bloc resection of large superficial colorectal tumors
which enables precise pathological diagnosis and a decrease in local recurrence compared to conventional
endoscopic mucosal resection (EMR) . ESD is indicated for colorectal lesions for which endoscopic en bloc
[1]

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
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