DOI: 10.1097/MPG.0000000000000376
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PMID: 26709909
Issn Print: 0277-2116
Publication Date: 2016/01/01
Endoscopic Submucosal Dissection of a Large Hamartoma in a Young Child
James Wall; Micaela Esquivel; Matias Bruzoni; Robert Wright; William Berquist; Craig Albanese
+ Author Information
Author Information: Division of Pediatric Surgery
Excerpt
Endoscopic submucosal dissection (ESD) is an evolving technique for the intraluminal resection of intestinal tumors. The technique uses commercially available endoscopic instruments to elevate the mucosa off of the submucosa, incise the mucosa, and dissect along the submucosal plane (1,2). It differs from standard endoscopic mucosal resection (EMR), which includes various techniques for lifting and snaring mucosal lesions without formal dissection of the submucosal plane. ESD enables en bloc resection of large and broad-based mucosal lesions that would otherwise require surgical resection. ESD has been applied extensively in Japan for the resection of early stage gastric malignancies. Although generally taking longer than EMR, it improves en bloc resection and allows precise pathologic analysis particularly in tumors greater than 2 cm in size (3). The risk of bleeding appears similar between ESD and EMR in a large meta-analysis; however, perforation rates are higher with ESD independent of the exact devices used (4). This may be a result of ESD being used to resect larger tumors with potentially larger vascular networks (5). Fortunately, perforation has not been linked to significant mortality and can typically be managed with a combination of endoscopic closure techniques and observation.
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