Gastroenterology in Motion

Endoscopic submucosal dissection (ESD) has developed into an accepted therapy for early gastroinestinal neoplasia, especially in Asian countries.1– 4 A ajor benefit of ESD is that it allows en bloc resection nd, thus, decreases risk of neoplastic recurrence.5 Western endoscopists have not embraced ESD techniques nearly as readily as their Eastern counterparts. This is likely due to a multitude of factors including low incidence of gastric malignancies, less exposure to ESD training, reimbursement issues, lengthy procedural times, and higher complication rates as compared to endoscopic mucosal resection (EMR).6 Methods that simplify the steps associated with ESD may help to proliferate its use. A new endoscopic gel (Cook Medical Inc, Winston-Salem, NC) was recently developed. This viscous gel was introduced for submucosal injection prior to excision of lesions of the gastrointestinal tract as the lesions are lifted by a visible bleb. Our exploratory laboratory experiments suggested that the gel also has tissue dissecting properties. Here, we present our initial experience with the use of this novel gel for facilitating submucosal dissection during gastric ESD.