Clin Endosc.  2020 Jul;53(4):497-498. 10.5946/ce.2020.031.

Effectiveness of Underwater Endoscopic Submucosal Dissection for a Superficial Cervical Esophageal Cancer

• Sasaki S
• Nishikawa J
• Yamamoto K
• Sakaida I

• KMID: 2504956
• DOI: http://doi.org/10.5946/ce.2020.031

Figure

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  Fig. 1. A superficial esophageal cancer involving the one third of the lumen was found in the cervical esophagus. Due to natural constriction, the lumen was narrow, and endoscopic observation was difficult. (A) Observation via narrow-band imaging revealed the tumor as a brownish area, and tumor blood vessels were dot shaped (B) Lugol staining showed that the tumor was unstained.

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  Fig. 2. Underwater endoscopic submucosal dissection was performed on the patient in the left lateral position with the electrosurgical unit (ERBE VIO 300D; Erbe Elektromedizin, Tübingen, Germany) using the following settings: endocut Q, effect 2, duration 3, interval 2; forced coagulation, effect 3, 30 W. (A) As the lumen of the esophagus was filled with 0.9% saline solution using a water pump, the lumen expanded that ensured a visual field and enabled mucosal incision. (B) The submucosal layer floated up, and submucosal dissection proceeded through all the layers without bleeding. (C) The lesion was resected en bloc. (D) Macroscopic image of the resected specimen after Lugol staining showed that the specimen size was 25 mm.

Reference

1. Binmoeller KF, Weilert F, Shah J, Bhat Y, Kane S. “Underwater” EMR without submucosal injection for large sessile colorectal polyps (with video). Gastrointest Endosc. 2012; 75:1086–1091.

2. Akutsu D, Suzuki H, Narasaka T, et al. Waterjet submucosal dissection of porcine esophagus with the HybridKnife and ERBEJET 2 system: a pilot study. Endosc Int Open. 2017; 5:E30–E34.

3. Yamaguchi N, Isomoto H, Nakayama T, et al. Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc. 2011; 73:1115–1121.

4. Ishaq S, Kuwai T. Rectal polyp reaching the dentate line: underwater EMR without submucosal lift. VideoGIE. 2017; 2:53–54.

5. Iacopini F, Gotoda T, Montagnese F, Andrei F, Saito Y. Underwater endoscopic submucosal dissection of a nonpolypoid superficial tumor spreading into the appendix. VideoGIE. 2017; 2:82–84.