Endoscopic mucosal resection and endoscopic submucosal dissection in esophageal and gastric cancers

Abstract

Purpose of review To summarize the literature to date on endoscopic mucosal removal techniques as applied to the upper gastrointestinal tract, predominantly the stomach and esophagus. This is an area that has rapidly advanced in terms of new procedures and techniques with a large body of outcomes that support their use. Recent findings The resection techniques can be divided into two forms, mucosal resection and submucosal dissection. Mucosal resection is typically done with cap techniques and is more suitable for removable of neoplastic lesions that are less than 1.5 cm in size. Submucosal dissection techniques are more difficult, associated with increased complications, and typically reserved for lesions greater than 1.5 cm and less than 3 cm in size. Ideal lesions for mucosal resection are generally flat and are located in areas easily accessible by the endoscope. Summary Endoscopic tissue removal methods are capable of removing neoplastic lesions en bloc in the upper gastrointestinal tract. These techniques fulfill cancer treatment guidelines by having histological confirmation of total removal of neoplastic lesions with assessment of the margins of resections. Long-term clinical outcomes of these techniques are emerging and seem promising in terms of disease-free and overall survival.

EUS for the staging of gastric cancer: a meta-analysis

“…[6][7][8][9][10] Moreover, different adjuvant and neoadjuvant chemotherapy (with or without with radiotherapy) regimens have been shown to provide significant survival advantage to patients with advanced gastric cancer. [11][12][13][14][15] These strategies require reliable staging procedures to ensure the most appropriate (ie, with the highest therapeutic index, the ratio between efficacy and toxicity) treatment for each patient, according to the principles of personalized medicine.…”

Current Status and Future Prospects for Esophageal Cancer Treatment

“…6) Among lesions that do not exceed the mucosal layer (T1a), those remaining within the mucosal epithelium (EP) or the lamina propria mucosae (LPM) are extremely rarely associated with LN metastasis; therefore, endoscopic resection is a sufficiently radical treatment for these lesions. 4) ESD was developed as a new endoscopic treatment in which the affected mucosa is incised and removed using a variety of endoscopic knives.…”

Diagnosis and Management of Barrett’s Esophagus with and Without Dysplasia

“…At now, EMR should be performed in BE patients who have dysplasia as macroscopically visible mucosal irregularities to determine the T stage of the neoplasia (151,(169)(170)(171)(172)(173)(174)(175). A large Endoscopy of GI Tractnumber of different techniques with or without suction or submucosal injection that raise the lesions can be used.…”

“…The main indications for curative endoscopic resection of early EAC included lesions limited to the mucosa, limited in size to 2 cm, well-to-moderately differentiated, no pathological lymph nodes, and no lymphovascular infiltration in the endoscopic resection specimen [187-190, 205, 206]. In ESD, a viscous fluid into the submucosal space is injected to provide a cushion under the lesion, followed by deeper resections into larger areas of submucosa using a special cutting device (knifes and snare) [174]. ESD has been used successfully for the treatment of large (> 1.5 cm) tumors of upper GI tract [207,208].…”

“…A large Endoscopy of GI Tractnumber of different techniques with or without suction or submucosal injection that raise the lesions can be used. EMR can be performed by the lift and snare technique, cap-assisted endoscopic resection, multiband mucosectomy, and Euroligator technique [169,170,[172][173][174][175]. Endoscopic submucosal dissection (ESD) is also used.…”