The key to hemorrhage prevention during endoscopic submucosal dissection

The key to successful endoscopic submucosal dissection (ESD) is hemostasis. This involves prior recognition and coagulation of the large blood vessels within the submucosal layer and performing careful dissection to avoid hemorrhage. Maximal reduction of hemorrhage risk with appropriate perioperative management and treatment strategies based on individual patients and lesions is essential for safe and reliable ESD. When using recently-developed equipment such as flex or dual knives, dissection can be performed with direct visualization of the blood vessels, and the chances of hemorrhage can be minimized through precoagulation.