Management of bleeding concerning endoscopic submucosal dissection with the flex knife for stomach neoplasm

Mitsuhiro Fujishiro, Naohisa Yahagi, Naomi Kakushima, Shinya Kodashima, Yosuke Muraki, Ayako Tateishi, Masao Omata

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)S119-S122
JournalDigestive Endoscopy
Issue numberSUPPL. 1
Publication statusPublished - 2006 Jul
Externally publishedYes


  • Bleeding
  • Endoscopic submucosal dissection
  • Flex knife
  • Hemostasis
  • Stomach neoplasm

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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