To an ecological endoscopic submucosal dissection: tips and tricks to reduce waste

Climate change is a global issue. By changing our habits, we can tackle the climate emergency and build a sustainable world. Every effort can contribute to modify the future of our planet. In medicine, some disciplines have already integrated the concept of environmental effects of unused pharmaceutical products [1] [2] [3] [4] . In the endoscopic field, the green change is not yet a daily practice.

We report a technique to remove traction using the knife during an endoscopic ubmucosal dissection (ESD). Here we describe two patients who underwent ESD for a colonic and a gastric superficial neoplasia, respectively ([Video 1]). A multi-traction technique was performed using a device of three intertwined loops. Each loop was attached to an edge of the lesion, and the entire device was attached to the opposite wall to facilitate the exposure of the submucosal area. Then an en bloc ESD was done. To remove the traction, we used the same knife by grasping the extremity of the clip with the point of the knife. The tumor was then removed gently using the knife and cap aspiration to pull it out of the patient. Hemostasis of the dissection plane was done using the same knife. Nevertheless, the use of the snare to remove the traction is still useful if the knife were to be re-used for endoscopy teaching because the knife would be damaged from removing the traction.

Video 1 To an ecological endoscopic submucosal dissection: tips and tricks to reduce waste.

Avoiding the snare to remove the traction is possible. Decreasing the use of the device during an endoscopic procedure is feasible. This technique will not change the patient tumor prognosis but will contribute to reduce waste and lessen our environmental impact. Every act counts to help to preserve our planet.

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• References

• 1 Pioche M, Lambin T, Rivory J. Let’s urgently engage ourselves in “greening” endoscopy to address ecological issues!. Endosc Int Open 2021; 09: E1752-E1753
• 2 Tauber J, Chinwuba I, Kleyn D. et al. Quantification of the cost and potential environmental effects of unused pharmaceutical products in cataract surgery. JAMA Ophthalmol 2019; 137: 1156
• 3 Thiel CL, Woods NC, Bilec MM. Strategies to reduce greenhouse gas emissions from laparoscopic surgery. Am J Public Health 2018; 108: S158-S164
• 4 Milford K, Rickard M, Chua M. et al. Medical conferences in the era of environmental conscientiousness and a global health crisis: the carbon footprint of presenter flights to pre-COVID pediatric urology conferences and a consideration of future options. J Pediatr Surg 2021; 56: 1312-1316