Endoscopic submucosal dissection for early gastrointestinal malignancies: Current state and future perspectives

Figure 1 Steps of endoscopic submucosal dissection. A: Endoscopic view of a rectal sessile polypoidal lesion; B: Narrow band imaging showing a Japanese Narrow Band Imaging Expert Team type 2B lesion; C: Marking around the lesion with a dual-knife; D: Submucosal injection with methylene blue; E: Submucosal dissection with a dual-knife; F: Base of the lesion after resection and one clip applied over a visible vessel to achieve hemostasis.

Figure 2 Novel prophylactic approach for highly vascular lesions. A: Sessile polypoidal lesion in the stomach; B: Endoscopic ultrasound showing increased vascularity; C: Pre-procedural super selective microcatheter angiogram (arrows indicate tumor blush) followed by coil embolization of the left gastric artery; D: Post-endoscopic submucosal dissection achieving a clear base.

Figure 3 Algorithm for the management of early gastrointestinal cancer. ¹Bleeding, perforation; ²Vide Table 1. GI: Gastrointestinal; ESD: Endoscopic submucosal dissection.