GASTRO 2009 report: putting endoscopy into perspective

Abstract

Various abstracts on endoscopic subjects were presented, many of which concentrated on innovations and new techniques, whereas others highlighted topics with an impact on clinical practice. This report focuses on oral presentations, as well as a few presented posters, which demonstrate latest advancements and research in gastrointestinal endoscopy and attempts to briefly review them in the light of recent literature.Endoscopic resection and other endotherapy techniques: from therapeutic endoscopy to endoscopic "surgery"? ! Endoscopic resection of premalignant lesions and early gastrointestinal cancers seems to be gradually coming of age, with a trend of shifting interest from the traditional piecemeal technique of endoscopic mucosal resection (EMR) to en bloc tissue resection by endoscopic submucosal dissection (ESD), although EMR remains a reasonable alternative for lesions < 20 mm or in Western centers, where experience in ESD is not as advanced as it is in Japan [1 -5]. Wide acceptance of endoscopic resection [6 -15] has lead to accumulation of experience, novel indications, and development of new instruments; this was reflected by various abstracts from Europe as well as from centers outside of Europe. The Wiesbaden group presented accumulated experience from their large cohort of 1059 patients with Barrett's esophagus (106 with high grade dysplasia, 819 with mucosal adenocarcinoma, and 134 with submucosal adenocarcinoma). Patients underwent endoscopic resection (2142 procedures) or photodynamic therapy (140 procedures) with a median follow-up of 56 months. Complete remission was achieved in 87 % of overall cases and 93.5 % of mucosal carcinomas, signifying efficacy and safety of endoscopic resection for these patients [16]. Accumulated experience with endoscopic resection led to the design of comparative studies between ESD and EMR; a retrospective study with 122 patients (162 superficial esophageal tumors), compared their efficacy [17]. Macroscopic and histological resection rates were better in the ESD group, significantly so for tumors > 20 mm, but nonsignificantly for tumors < 20 mm (P < 0.001 and P = 0.09, respectively); complication rates did not differ and local recurrence was 7.9 % for EMR and 0 % for ESD. As expected, average operation time was significantly longer for ESD, irrespective of tumor size. Superiority of ESD compared with EMR in minimizing local recurrence of esophageal tumors > 20 mm was highlighted in a large series from Japan [18]. Here the authors continued previous work [19] and presented a series of 106 lesions treated with endoscopic resection. There were 11/57 local recurrences in the EMR group versus 1/49 in the ESD group. Comparison of outcomes of esophageal endoscopic resection depending on histology (adenocarcinoma vs. squamous cell carcinoma) was examined in two studies. The first study, a European retrospective series, compared long-term safety and efficacy of endoscopic resection in 85 patients with mucosal squamous cell carcinoma with 98 Barrett carcinomas. Initial and lo...