Endoscopic Resection of Malignancies in the Upper GI Tract: A Clinical Algorithm

Area of Science:

• Gastroenterology and Endoscopy
• Oncology
• Surgical Pathology

Background:

• Early-stage upper gastrointestinal malignancies are often suitable for endoscopic resection.
• Curative resection is the primary quality metric, necessitating robust post-resection risk assessment and aftercare protocols.

Purpose of the Study:

• To present clinical algorithms for the endoscopic resection of esophageal squamous cell carcinoma (SCC), Barrett's neoplasia, and gastric neoplasia.
• To outline pre-resection assessment strategies, including lesion and margin evaluation, and appropriate resection technique selection.
• To detail post-resection risk assessment based on histopathology and provide evidence-based recommendations for follow-up and surveillance.

Main Methods:

• Utilizing chromoendoscopy and high-definition (HD) technology for precise pre-resection endoscopic assessment.
• Delineating lateral resection margins meticulously before endoscopic resection.
• Applying endoscopic submucosal dissection (ESD) as the standard for esophageal SCC and gastric carcinoma; favoring en bloc resection for large or invasive Barrett's neoplasia.

Main Results:

• Accurate pre-resection assessment and margin delineation are crucial for achieving curative endoscopic resections.
• The choice of resection technique, such as ESD or en bloc resection, impacts curative outcomes.
• Histopathological risk assessment post-resection is essential for determining the individual patient's risk of lymph node metastasis and guiding subsequent management.

Conclusions:

• Clinical algorithms integrating pre-resection assessment, technique selection, and post-resection risk stratification enhance the quality of endoscopic resection for upper GI neoplasias.
• Evidence-based follow-up and surveillance strategies are critical components of comprehensive care following endoscopic resection.