Implementation of Endoscopic Submucosal Dissection for Early Colorectal Neoplasms in Sweden
Figure 1
Standard procedure for colorectal ESD. (a) A large (3 × 4 cm) laterally spreading tumor-nongranular type in the transverse colon is delineated by use of topical application of indigo carmine. One can also see the frontal part of the disposable hood. (b) The lesion is elevated by submucosal injection of hyaluronic acid solution, and the anal part of the tumor has been incised by use of a Flush-knife. (c) The Flush-knife is used to dissect the submucosa and separate it from muscularis propria. (d) When approximately half of the lesion has been separated from the muscularis propria, the mucosal incision is completed around the lesion. (e) The lesion has been resected en bloc, and the remaining ulcer is examined for potential perforations and exposed blood vessels to coagulate. (f) The resected specimen is stretched and nailed to facilitate histological examination.
