Underwater endoscopic submucosal dissection with nasal intubation using a small-bore tracheal tube for an early epiglottic lesion

Underwater endoscopic submucosal dissection with nasal intubation using a small-bore tracheal tube for an early epiglottic lesion A 60-year-old man was diagnosed during gastroscopy with an early neoplastic lesion on the lingual surface of the epiglottis.He had a history of long-term alcohol consumption.The lesion, measuring approximately 1.5 2.0 cm, was identified as a superficial, flat (0-IIb) area with a clear boundary, exhibiting a reddish hue under white light ( Fig. 1 a) and appearing brown under narrowband imaging (NBI) ( Fig. 1 b).Following biopsy, histopathological examination confirmed high grade intraepithelial neoplasia (HGIN), and computed tomography (CT) scans showed no evidence of metastasis.After informed consent had been obtained, the patient underwent endoscopic submucosal dissection (ESD) with tracheal intubation, facilitated by the nasal insertion of a 6.0-mm small-bore tracheal tube ( Video 1).The lesion was distinctly marked under magnifying endoscopy.Given the confined space of the epiglottis, identifying the optimal dissection layer was challenging.To address this, following a circumferential mucosal incision performed using a Goldknife (Micro-tech, Nanjing, China) ( Fig. 2 a), the dissection was performed using the water immersion method, which effectively exposed the dissection plane ( Fig. 2 b,c).The procedure was executed successfully without complications such as bleeding or perforation ( Fig. 2 d).Postoperative pathology confirmed HGIN with negative resection margins.At 1 month post surgery, the patient showed a satisfactory recovery with normal swallowing function preserved.ESD has emerged in recent years as an effective and less invasive treatment for early pharyngeal lesions, enhancing patients' postoperative quality of life [1].The limited space of the epiglottic region E-Videos Fig. 1 Endoscopic images of an early neoplastic lesion on the lingual surface of the epi- glottis: a superficial flat lesion, exhibiting a reddish hue under white light; b brown-colored appearance under narrow-band imaging. Fig. 2 Underwater endoscopic submucosal dissection (ESD) procedure.a Circumferential mucosal incision of the lesion.b, c Dissection performed using the water immersion method.d Macroscopic appearance of the resected lesion.