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Endoluminal resection and tissue acquisition.

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Endoscopic resection techniques like endoscopic submucosal dissection enable en bloc removal of gastrointestinal lesions. Newer methods, such as endoscopic submucosal tunneling, address deeper tumors with promising outcomes.

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Endoscopic Procedures

Background:

  • Endoscopic resection is indicated for early gastrointestinal cancers and adenomas.
  • Limitations of endoscopic mucosal resection (EMR) for larger lesions (>2 cm) included inability for en bloc resection and margin assessment.
  • Endoscopic submucosal dissection (ESD) improved en bloc resection rates for superficial gastrointestinal cancers.

Purpose of the Study:

  • To review the evolution and application of endoscopic resection techniques for gastrointestinal lesions.
  • To highlight the advancements from EMR to ESD and newer tunneling techniques.
  • To discuss the feasibility and outcomes of endoscopic resection for submucosal lesions.

Main Methods:

  • Review of endoscopic resection techniques, including EMR, ESD, and endoscopic submucosal tunneling.
  • Analysis of indications, limitations, and outcomes for each technique.
  • Application of techniques to lesions in the mucosal, submucosal, and muscularis propria layers.

Main Results:

  • EMR was limited for lesions >2 cm, risking incomplete resection.
  • ESD allows en bloc resection of superficial esophageal, gastric, and colon cancers with high success rates.
  • Endoscopic submucosal tunneling shows promise for resecting tumors in the muscularis propria layer without perforation.

Conclusions:

  • Endoscopic resection techniques are evolving for gastrointestinal neoplasms.
  • ESD offers improved outcomes for superficial cancers compared to EMR.
  • Endoscopic submucosal tunneling presents a novel approach for deeper submucosal lesions.