Esophageal squamous cell cancer (ESCC) has a dismal prognosis mainly because its recognition in Western countries usually occurs in late stages, when the possibilities of cure are minimal. However, in recent years, several advances have been observed in the management of ESSC, such as the identification of high-risk patients, the use of high-resolution endoscopy and lugol chromoscopy favoring the diagnosis of early stage ESCC, and the development of endoluminal techniques of en-block tumor resection, namely endoscopic submucosal dissection (ESD). These factors have enabled the application of endoscopic minimally invasive curative interventions in selected patients with superficial ESCC. This review article, designed by a multicenter international group, has the primary objective to provide a comprehensive overview of the most important recent advances in the management of ESCC. Secondarily it intends to provide a detailed and practical description of the technical approach to ESD in order to facilitate the dissemination of this concept and the incorporation of this new technologies in Brazil and in Latin-America.
In order to expand the availability of endoscopic submucosal dissection (ESD),
measures to facilitate the procedure are necessary. When bleeding occurs, the
examiner’s field of vision is critically impaired, and ESD becomes less
efficient and more hazardous because of the presence of submucosal hematoma and
covered blood clot. We propose the use of polyethylene glycol (PEG) irrigation
as a simple and effective measure to improve visibility during submucosal
dissection, particularly when bleeding occurs. PEG irrigation facilitates
further dissection by allowing a better recognition of the submucosal fibers and
muscularis propria layer.
La esofagitis necrotizante aguda (esófago negro) es una patología grave poco frecuente que se caracteriza por presentar pérdida parcial o total del epitelio con ulceración hasta el esfacelo circunferencial de todas las capas de la mucosa y submucosa con compromiso frecuente de capas profundas musculares y perforación, con aspecto negruzco al examen endoscópico, que le ha dado su nombre más conocido, de esófago negro. Se presentan cinco casos ilustrativos concordantes con la descripción de la literatura médica, la cual se revisa y reportan todos los casos descritos, junto con los factores de riesgo y pronóstico
La endomicroscopia confocal láser basada en probes (Cellvizio de Mauna Kea Technologies, París) es una nueva tecnología que permite, durante cualquier procedimiento endoscópico, realizar análisis histológicos en tiempo real (biopsia óptica), mejorando el diagnóstico y ayudando a definir el tratamiento de múltiples patologías digestivas. Es de resaltar, para nuestro medio, su utilidad en patologías de difícil diagnóstico como son las estenosis biliares indeterminadas y las neoplasias quísticas pancreáticas, cuyo diagnóstico temprano y exacto es muy difícil con las técnicas actualmente disponibles, y que es necesario para definir la realización o la exclusión de tratamientos quirúrgicos de alta morbimortalidad y alto costo, como por ejemplo, la cirugía de Whipple. En esta revisión se muestran los aportes actuales de esta tecnología, ya disponible en nuestro medio, para el diagnóstico y estudio de las patologías digestivas.
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