title: Duodenal ESD: conquering difficulties.
abstract: Duodenal endoscopic submucosal dissection (ESD) is technically difficult due to the unique anatomic features. The risks include intraprocedural complications, delayed bleeding, and perforation. A small-caliber-tip transparent hood is useful. Mechanical stretching of the submucosal tissue allows safe dissection and effective prevention of bleeding with minimum muscle injury under direct visualization of the submucosal tissue and blood vessels. A short double-balloon endoscope is useful to stabilize control of the endoscope tip in distal duodenal ESD. Selection of ESD in the duodenum should be made cautiously considering both benefits and risks of the procedure.
authors.affiliation: Gastroenterology Center, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan. Electronic address: ireef@jichi.ac.jp.
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: Gastroenterology Center, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Miura
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004210:Dissection / Q000379:methods; D004378:Duodenal Diseases / Q000517:prevention & control*; D004379:Duodenal Neoplasms / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D007416:Intestinal Perforation / Q000517:prevention & control*; D018579:Patient Selection; D019106:Postoperative Hemorrhage / Q000517:prevention & control*
keywords: Carcinoma; Duodenal adenoma; Endoscopic submucosal dissection; Small-caliber-tip transparent hood; Sodium hialuronate; Therapy; Tunneling method