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MANAGEMENT OF BLEEDING CONCERNING ENDOSCOPIC SUBMUCOSAL DISSECTION WITH THE FLEX KNIFE FOR STOMACH NEOPLASM
Author(s) -
Fujishiro Mitsuhiro,
Yahagi Naohisa,
Kakushima Naomi,
Kodashima Shinya,
Muraki Yosuke,
Tateishi Ayako,
Omata Masao
Publication year - 2006
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.2006.00638.x
Subject(s) - medicine , endoscopic submucosal dissection , submucosa , stomach , surgery , endoscopic mucosal resection , endoscopy
Management of bleeding is crucial for a successful endoscopic submucosal dissection (ESD) with the Flex knife for a stomach neoplasm. Medical approaches to suppress gastric acid secretion and keep systolic blood pressure at the level of < 150 mmHg during ESD are tried to lessen bleeding. But, major concerns for bleeding are whether the blood vessels are cut off or not and endoscopic surgeons have to avoid blind application of devices for ESD as much as possible. Even in the situations where blind application for non‐visible vessels in the submucosa is not preventable such as in the steps of marking, submucosal injection, mucosal incision, and snaring, the efforts to lessen bleeding are necessary. When non‐bleeding visible vessels are noticed, ‘prebleeding coagulation’ with appropriate devices is important. Even if unexpected bleeding occurs, it is also controllable using appropriate devices according to the type of bleeding. All endscopists who perform ESD should also be experts in management of bleeding.