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Wei MT, Friedland S, Hwang JH. The Current Landscape of Endoscopic Submucosal Training in the United States. Curr Gastroenterol Rep 2025; 27:4. [PMID: 39509015 DOI: 10.1007/s11894-024-00950-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2024] [Indexed: 11/15/2024]
Abstract
PURPOSE OF REVIEW Endoscopic submucosal dissection (ESD) has been found to increase en bloc and R0 resection as well as decrease risk of recurrence. However, despite literature supporting the benefits of endoscopic submucosal dissection, adoption of ESD in the United States has been challenging, driven by factors including requirement for specialized training as well as limitations in training availability. RECENT FINDINGS Many devices have been developed to improve ease and therefore adoption for the procedure, with advancements in stability, resection as well as closure of the mucosal defect following resection. While the Japanese model of training in ESD centers around the Master-Apprentice model, this is scarce in the United States. Most US endoscopists therefore must follow other paths to learn and become proficient at ESD. There has been a rapid expansion in literature on ESD, fellowship programs, opportunities for case observation, and significant evolution in ex vivo training models that can assist an endoscopist in receiving training in ESD. Currently, there are three main ways of learning to perform ESD in the United States: 1. Third space endoscopy fellowship; 2. Master-apprentice model; 3. Utilization of live courses and proctored procedures. ESD is the optimal method to ensure en bloc resection of large mucosal neoplasms of the gastrointestinal tract. While several barriers hinder adoption of ESD in the United States, there has been significant development both in procedural and training aspects. Further research and discussions are needed to determine criteria for credentialing and proficiency in ESD.
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Affiliation(s)
- Mike T Wei
- Stanford University, Stanford, CA, United States.
| | - Shai Friedland
- Stanford University, Stanford, CA, United States
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Joo Ha Hwang
- Stanford University, Stanford, CA, United States
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2
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Keihanian T, Khalaf M, Ayoub F, Boroujeni EK, Jawaid SA, Othman MO. Outcomes of Colonic Endoscopic Submucosal Dissection and Advanced Tissue Resection in Obese Patients: An Analysis of a Large Western Cohort. Dig Dis Sci 2025:10.1007/s10620-025-08990-4. [PMID: 40131700 DOI: 10.1007/s10620-025-08990-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2025] [Accepted: 03/11/2025] [Indexed: 03/27/2025]
Abstract
BACKGROUND AND AIM Colonic endoscopic submucosal dissection (ESD) and advanced tissue resection (ATR) in obese patients present challenges, including limited scope maneuverability, instability from abdominal fat, and slower dissection due to poor conductivity of submucosal fat. This study aims to assess the impact of obesity on colonic ESD outcomes in a large Western cohort. METHOD This retrospective study analyzed patients who underwent colonic ESD and ATR at a US tertiary institution from April 2017 to July 2024. Patients were categorized by body mass index (BMI): control (< 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2), and obese (≥ 30 kg/m2). Multinomial logistic regression and univariate analysis were performed to evaluate the impact of weight status on clinical success, procedure time, and adverse events. RESULTS A total of 637 patients were included (Control: 175, Overweight: 227, Obese: 235). En bloc resection (86.9% vs. 82.4% vs. 85.1%, P = 0.77) and R0 resection (78.9% vs. 72.2% vs. 74.5%, P = 0.16) were similar across groups. Obese patients had a significantly lower R0 resection rate for left-sided colonic lesions (P = 0.046). Also, obese patients more frequently required an overtube for dissection, especially for right-sided lesions (80% vs. 66%, P = 0.04). Procedure times were similar (P = 0.445), and 74.4% were safely discharged on the same day. Lack of defect closure (OR 3.072, CI 1.382-6.828) and longer procedure time (OR 1.017, CI 1.011-1.023) predicted post-procedure admission. No significant differences in adverse events were observed. CONCLUSION Obese patients had a significantly lower R0 resection rate for left-sided colonic lesions and frequently required an overtube to facilitate the dissection of right-sided colonic lesions.
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Affiliation(s)
- Tara Keihanian
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| | - Mai Khalaf
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Fares Ayoub
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| | | | - Salmaan A Jawaid
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| | - Mohamed O Othman
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA.
- Section of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, 7200 Cambridge Street, Suite 8C, Houston, TX, 77030, USA.
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Gupta S, He T, Mosko JD. Endoscopic approach to large non-pedunculated colorectal polyps. J Can Assoc Gastroenterol 2025; 8:S62-S73. [PMID: 39990513 PMCID: PMC11842907 DOI: 10.1093/jcag/gwae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2025] Open
Abstract
Large non-pedunculated colorectal polyps ≥20 mm (LNPCPs) constitute approximately 1% of all colorectal polyps and present a spectrum of risks, including overt and covert submucosal invasive cancer (T1 colorectal cancer (CRC)). Importantly, a curative resection may be achieved for LNPCPs with superficial T1 CRC (T1a or T1b <1000 µm into submucosa), if an enbloc R0 excision (clear margins) with favourable histology is achieved (ie, absence of high-grade tumour budding, lympho-vascular invasion, and poor differentiation). Thus, while consensus recommendations advocate for endoscopic resection as the primary treatment option for LNPCPs, thorough optical assessment is imperative for selecting the most suitable ER strategy. In this review, we highlight the critical components of optical evaluation that assist in predicting the risk of T1 CRC, including morphology (Paris and LST classifications), surface pit/vascular pattern (JNET and Kudo classifications), and lesion location. Different resection modalities, including endoscopic submucosal dissection and endoscopic mucosal resection are discussed, along with important considerations that may influence the resection strategy of choice, such as access to the LNPCP and submucosal fibrosis.
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Affiliation(s)
- Sunil Gupta
- Division of Gastroenterology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, NSW 2145, Australia
| | - Tony He
- Division of Gastroenterology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
| | - Jeffrey D Mosko
- Division of Gastroenterology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
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Chang SF. Unsedated colonoscopy: Are we there yet? Gastrointest Endosc 2025; 101:414-415. [PMID: 39892971 DOI: 10.1016/j.gie.2024.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 10/18/2024] [Accepted: 10/18/2024] [Indexed: 02/04/2025]
Affiliation(s)
- Stanley F Chang
- Fresno Program, University of California San Francisco, San Francisco, California, USA.
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Jawaid S, Aboelezz AF, Daba G, Khalaf M, Ayoub F, Zabad N, Mercado M, Keihanian T, Othman M. Prospective feasibility study of a novel rigidizing stabilizing overtube in the resection of complex gastrointestinal polyps. Endoscopy 2025; 57:68-73. [PMID: 38991535 DOI: 10.1055/a-2350-4059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
BACKGROUND A novel rigidizing overtube (ROT) was developed to facilitate endoscopic removal of complex gastrointestinal polyps. We aimed to prospectively evaluate the efficacy and safety of the device in the management of large gastrointestinal polyps. METHODS A prospective, single-center study, conducted between May 2021 and April 2023, enrolled patients undergoing endoscopic resection of colon/duodenal polyps ≥25 mm. Primary outcomes were safety, technical success, and clinical success defined as the ability of ROT to facilitate endoscopic polyp removal without changing the initial resection method. RESULTS 97 patients (98 polyps), with a mean polyp size of 33.2 mm (median 31.1), were evaluated. Technical and clinical success rates were 100% and 84%, respectively. Ileocecal valve location was the only predictor of clinical failure (P = 0.02). The mean time to reach the lesion was 7.2 minutes (95%CI 5-8), with overall resection and procedure times of 53.6 minutes (95%CI 48-61) and 88.9 minutes (95%CI 79-95), respectively. No device-related adverse events occurred. Lower technical (67%) and clinical (67%) success rates were seen for duodenal polyps (n = 6). CONCLUSION The novel ROT was safe, with high technical and clinical success during resection of complex colon polyps. Future studies will determine timing of implementation during routine endoscopic resection.
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Affiliation(s)
- Salmaan Jawaid
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, United States
| | - Ahmed F Aboelezz
- Department of Internal Medicine, Gastroenterology and Hepatology Unit, Tanta University, Tanta, Egypt
| | - Gehad Daba
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, United States
| | - Mai Khalaf
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, United States
| | - Fares Ayoub
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, United States
| | - Noor Zabad
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, United States
| | - Michael Mercado
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, United States
| | - Tara Keihanian
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, United States
| | - Mohamed Othman
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, United States
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Miller A, Anderson JC. Strategies, Technologies, and Tips for Successful Cecal Intubation. J Clin Gastroenterol 2025; 59:16-23. [PMID: 39495781 DOI: 10.1097/mcg.0000000000002096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Accepted: 10/02/2024] [Indexed: 11/06/2024]
Abstract
Successful cecal intubation is crucial in ensuring a complete evaluation of the colonic mucosa. Although completion of colonoscopies should be successful in close to 100% of all examinations in the hands of experienced gastroenterologists, there are some patients with colons which can be difficult to navigate. Factors such as older age, presence of diverticular disease, as well as high or low body mass index can present challenges for endoscopists. Challenges can be divided into those that are left sided and are associated with severe angulations of the colon versus those that are right sided and present as redundant colons. Both require different strategies to achieve completion. This review will cover methods, technologies as well the evolution of colonoscope insertion tubes which can help in navigating colons, especially those that are challenging. There will also be a discussion about basic principles and techniques that should be employed in all colonoscopies.
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Affiliation(s)
| | - Joseph C Anderson
- University of Connecticut, School of Medicine
- Geisel School of Medicine at Dartmouth, Hanover, NH
- White River Junction VAMC, White River Junction, VT
- NH Colonoscopy Registry, Lebanon, NH, USA
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Parra-Blanco A. Overtubes: a bridge to successful colonoscopic resection? Endoscopy 2025; 57:74-76. [PMID: 39227018 DOI: 10.1055/a-2386-9098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Affiliation(s)
- Adolfo Parra-Blanco
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom of Great Britain and Northern Ireland
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8
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Wei MT, Friedland S. Strategies to manage the difficult colonoscopy. World J Gastrointest Endosc 2023; 15:491-495. [PMID: 37547242 PMCID: PMC10401407 DOI: 10.4253/wjge.v15.i7.491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/22/2023] [Accepted: 06/19/2023] [Indexed: 07/12/2023] Open
Abstract
During endoscopy, an endoscopist is inevitably faced with the occasional “difficult colonoscopy,” in which the endoscopist finds it challenging to advance the endoscope to the cecum. Beyond optimization of technique, with minimized looping, minimal insufflation, sufficient sedation, and abdominal splinting when needed, sometimes additional tools may be needed. In this review, we cover available techniques and technologies to help navigate the difficult colonoscopy, including the ultrathin colonoscope, rigidizing overtube, balloon-assisted colonoscopy and the abdominal compression device.
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Affiliation(s)
- Mike T Wei
- Department of Gastroenterology, Stanford University Medical Center, Palo Alto, CA 94306, United States
| | - Shai Friedland
- Department of Gastroenterology, Stanford University Medical Center, Palo Alto, CA 94306, United States
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Wei MT, Ahn JY, Friedland S. Over-the-Scope Clip in the Treatment of Gastrointestinal Leaks and Perforations. Clin Endosc 2021; 54:798-804. [PMID: 34872236 PMCID: PMC8652163 DOI: 10.5946/ce.2021.250] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/08/2021] [Indexed: 12/18/2022] Open
Abstract
While perforations, postoperative fistulas, and leaks have traditionally led to surgical or interventional radiology consultation for management, the introduction of the over-the-scope clip has allowed increased therapeutic possibilities for endoscopists. While primarily limited to case reports and series, the over-the-scope clip successfully manages gastrointestinal bleeding, perforations, as well as postoperative leaks and fistulas. Retrospective studies have demonstrated a relatively high success rate and a low complication rate. Given the similarity to variceal banding equipment, the learning curve with the over-the-scope clip is rapid. However, given the higher risk of procedures involving the use of the over-the-scope clip, it is essential to obtain the scope in a stable position and grasp sufficient tissue with the cap using a grasping tool and/or suction. From our experience, while closure may be successful in lesions sized up to 3 cm, successful outcomes are obtained for lesions sized <1 cm. Ultimately, given the limited available data, prospective randomized trials are needed to better evaluate the utility of the over-the-scope clip in various clinical scenarios, including fistula and perforation management.
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Affiliation(s)
- Mike T Wei
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ji Yong Ahn
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Shai Friedland
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
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10
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Lambin T, Rivory J, Wallenhorst T, Legros R, Monzy F, Jacques J, Pioche M. Endoscopic submucosal dissection: How to be more efficient? Endosc Int Open 2021; 9:E1720-E1730. [PMID: 34790536 PMCID: PMC8589544 DOI: 10.1055/a-1554-3884] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/13/2021] [Indexed: 11/09/2022] Open
Abstract
Endoscopic submucosal dissection (ESD) allows an "en bloc" resection with safety margins (R0 resection) regardless of the size of the lesion. However, while R0 brings a real benefit for the patient, it is not considered sufficient by many experts to justify the technical difficulties and the longer procedure time compared to piecemeal mucosectomy. The aims of this review are to provide several technical and strategical tips to help you save time and become comfortable during ESD procedures. ESD is divided into several intertwined phases: injection, incision, access to the submucosae, and submucosal dissection itself. During injection there are some mistakes that should not be made: a superficial injection, or on the contrary, a too deep injection. A good needle and good injection technique are mandatory. Some techniques, such as repeated injection or prolonged lifting solution, can help maintain the lift. After this step, mucosal incision can be made, taking care to have a good margin to allow an R0 resection. Starting the mucosal incision from a small point allows calibration of the depth of the incision and then obtaining a nice incision. Trimming is also very important to widen submucosal access. Then comes the submucosal dissection itself. Strategies such as the tunnel strategy or the pocket creation method can help to facilitate dissection, but more importantly, traction systems have become unavoidable, especially in the stomach and colon. Most common complications are bleeding and perforation, and they usually can be managed endoscopically.
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Affiliation(s)
- Thomas Lambin
- Gastroenterology and Endoscopy Unit, Pavilion L, Edouard Herriot Hospital, Lyon, France,Inserm U1032, Labtau, Lyon, France
| | - Jérôme Rivory
- Gastroenterology and Endoscopy Unit, Pavilion L, Edouard Herriot Hospital, Lyon, France
| | - Timothée Wallenhorst
- Department of Gastroenterology, Pontchaillou University Hospital, Rennes, France
| | - Romain Legros
- Gastroenterology and Endoscopy Unit, Dupuytren university Hospital, Limoges, France
| | | | - Jérémie Jacques
- Gastroenterology and Endoscopy Unit, Dupuytren university Hospital, Limoges, France
| | - Mathieu Pioche
- Gastroenterology and Endoscopy Unit, Pavilion L, Edouard Herriot Hospital, Lyon, France,Inserm U1032, Labtau, Lyon, France
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Coronel M, Coronel E, Romero L, Ge PS. Combination of a dynamic rigidizing overtube and a novel injectable needle-type knife to facilitate colorectal endoscopic submucosal dissection. VideoGIE 2021; 6:297-300. [PMID: 34278090 PMCID: PMC8267954 DOI: 10.1016/j.vgie.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Martin Coronel
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emmanuel Coronel
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Laura Romero
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Phillip S Ge
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Tan X, Yang W, Wichmann D, Huang C, Mothes B, Grund KE, Chen Z, Chen Z. Magnetic endoscopic imaging as a rational investment for specific colonoscopies: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2021; 15:447-458. [PMID: 33267703 DOI: 10.1080/17474124.2021.1842192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Magnetic endoscopic imaging (MEI) was regarded as an adjuvant device to improve procedural efficacy and patients' comfort during colonoscopy. METHODS Several electronic databases were searched to identify eligible studies. Based on the heterogeneity of included studies, random-effects or fixed-effects models were used to calculate pooled risk ratios (RR), risk difference (RD) or mean difference (MD) along with 95% confidence intervals (CIs). RESULTS Twenty-one randomized controlled trials (RCTs) were selected for meta-analysis, with a total of 7,060 patients. Although there is a slightly lower risk of cecal intubation failure with the adjuvant of MEI (RD 3%; P < 0.00001) compared to the control group, the updated studies show no significant benefits. Similarly, the cecal intubation time, pain scores, and loop formation with the adjuvant of MEI did not show any advantages. However, considerable significant benefits were found in the subgroup of technically difficult colonoscopy and inexperienced colonoscopists. Moreover, MEI was associated with lower loop intubation time, lower abdominal compression times, and better lesion localization. CONCLUSION The clinical benefits of MEI could be exaggerated. However, MEI has considerable advantages in technically difficult colonoscopies, the assistance for inexperienced colonoscopists, loop resolving, and lesion localization.
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Affiliation(s)
- Xiangzhou Tan
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital Central South University, Changsha, Hunan Province, China.,Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Weimin Yang
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital Central South University, Changsha, Hunan Province, China.,Department of General Surgery, Huaihua Hospital Affiliated to University of South China, Huaihua, Hunan Province, China
| | - Doerte Wichmann
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Changhao Huang
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Benedikt Mothes
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - K E Grund
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Zhikang Chen
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital Central South University, Changsha, Hunan Province, China
| | - Zihua Chen
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital Central South University, Changsha, Hunan Province, China
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Wei MT, Triadafilopoulos G, Friedland S. The Mettle to Use the Petals: Using Over-the-Scope Rings to Optimize Endoscopic Submucosal Dissection. Dig Dis Sci 2021; 66:989-993. [PMID: 32909123 DOI: 10.1007/s10620-020-06596-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Mike T Wei
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, 300 Pasteur Drive, Palo Alto, CA, 94305, USA. .,Veterans Affairs Palo Alto, Palo Alto, CA, USA.
| | - George Triadafilopoulos
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, 300 Pasteur Drive, Palo Alto, CA, 94305, USA
| | - Shai Friedland
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, 300 Pasteur Drive, Palo Alto, CA, 94305, USA.,Veterans Affairs Palo Alto, Palo Alto, CA, USA
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