Lui Ka Luen
The Chinese University of Hong Kong, China
Title: Endoscopic submucosal dissection: Prospectives on complication prevention and medical comorbidites
Biography
Biography: Lui Ka Luen
Abstract
The endoscopic submucosal dissection is the standard of care for the management of early malignant or premalignant neoplasm in the gastrointestinal tract. However, patients with these lesions are often accompanied with significant medical comorbidities. Such as, patients on oral anticoagulation with high thrombotic risk e.g., mitral valve replacement, dual valve replacement, recent myocardial infarction with intervention, end stage renal failure, poorly controlled diabetes, conditions with high anesthetic risk, etc. Patients with these high-risk medical conditions often increase both endoscopic and non-endoscopic complication rate. Combination of careful optimization of medical condition, pre-endoscopic preparation, special endoscopic technique and post-endoscopic management is a must to acheive low complication rate for these high risk population. Endoscopic techniques for prevention of rebleeding included careful identification of all vessels under indigo carmen-free submucosal plane, precoagulation of big vessels, submucosal dissection using coagulation mode, liberal use of coagulation forceps to eradicate all vessel heads at the post ESD wound and prophylactic closure of post ESD wound. Endoscopic techniques for prevention of perforation included maintainance of a good and clear view (Only cut when you see) in an indigo carmen free submucosal plane and prevention of any active bleeding, maintainance of the direction of knife parallel to muscle layer and the direction of cutting away from the muscle layer together with a good traction and slight hooking of tissue (ball-tube type of knife) especially when the direction of knife is perpendicular to the muscle layer. Use of coagulation mode for submucosal dissection is also the key.