Multiband mucosectomy for advanced dysplastic lesions in the upper digestive tract

Abstract

Endoscopic resection (ER) is at present an accepted treatment for superficial gastrointestinal neoplasia. ER provides similar efficacy to surgery; however, it is minimally invasive and less expensive. Endoscopic mucosal resection (EMR) is superior to biopsy for diagnosing advanced dysplasia and can change the diagnostic grade and the management. Several EMR techniques have been described that are alternatively used dependent upon the endoscopist personal experience, the anatomic conditions and the endoscopic appearance of the lesion to be resected. The literature suggests that EMR offers comparable outcomes to surgery for selected indications. EMR techniques using a cap fitted endoscope and EMR using a ligation device [multiband mucosectomy (MBM)] are the most frequently use. MBM technique does not require submucosal injection as with the endoscopic resection-cap technique, multiple resections can be performed with the same snare, pre-looping the endoscopic resection-snare in the ridge of the cap is not necessary, MBM does not require withdrawal of the endoscope between resections and up to six consecutive resections can be performed. This reduces the time and cost required for the procedure, while also reducing patient discomfort. Despite the increasing popularity of MBM, data on the safety and efficacy of this technique in upper gastrointestinal lesions with advanced dysplasia, defined as those lesions that have high-grade dysplasia or early cancer, is limited.

Multiband mucosectomy for the treatment of challenging non-pedunculated colorectal polyps

“…Multiband mucosectomy (MBM) is a technique that has been successfully carried out in esophageal and gastric lesions [8], with outcomes similar to and in a faster time than traditional EMR [9]. This technique has also been shown to be equivalent to ESD in treating rectal carcinoid [10].…”

Epidemiology, Diagnosis, Staging and Multimodal Therapy of Esophageal and Gastric Tumors

“…Cap-assisted EMR involves submucosal injection to lift the target lesion from the mucosa, isolating the lesion within a transparent “cap” mounted on the tip of the endoscope, gentle suction, followed by resection of the lesion using the pre-deployed snare within the cap using electrocautery [ 53 ]. MBM involves suction of target tissue into an endoscopic band-ligation device and deployment of a band over the target lesion followed by resection of the tissue with electrocautery snaring [ 54 ]. EMR can be either stepwise/complete (sEMR) or focal (fEMR), with focal EMR often combined with RFA.…”

Endoscopic management of Barrett’s dysplasia and early neoplasia: efficacy, safety and long-term outcomes in a UK tertiary centre

“…This process is repeated until the lesion is completely resected. [21] The second method is termed the cap assisted EMR (EMR-C) technique (Olympus, Tokyo, Japan). A transparent cap is attached to gastroscope and the lesion is then raised with submucosal solution containing gelofusine and adrenaline or gelofusine alone.…”