Clin Endosc.  2023 Nov;56(6):738-740. 10.5946/ce.2023.195.

Understanding hybrid endoscopic submucosal dissection subtleties

• Pontual JPdS
• Bestetti AM
• de Moura DTH

• KMID: 2547894
• DOI: http://doi.org/10.5946/ce.2023.195

Figure

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  Fig. 1. Standard and hybrid endoscopic submucosal dissection (ESD) techniques. EMR, endoscopic mucosal resection.

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  Fig. 2. Standard hybrid endoscopic submucosal dissection. (A) A large laterally spreading tumor–granular type with a bulky nodule in the low­er rectum. (B) Demarcation and circumferential mucosal incision of the lesion. (C, D) Partial submucosal dissection. (E) Snare resection. (F) A resected lesion. (G, H). Resection bed after the procedure. (I) Mucosal closure was performed with endoscopic su­turing.

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  Fig. 3. Rescue hybrid endoscopic submucosal dissection. (A) A large laterally spreading tumor–granular type with a bulky nodule in the proximal transverse colon. (B, C) Perforation during mucosal incision. (D) Immediate closure with endoscopic clipping. (E, F) Piecemeal snare resection. (G, H) Resection bed after the procedure. (I) Mucosal closure was performed with endoscopic suturing.

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