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Endoscopic Biopsy Demonstrating High-Grade Dysplasia in Barrett’s Esophagus
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Endoscopic mucosal resection entails targeting an area of concern, creation of a pseudopolyp, and using a snare and electocautery to excise a 1–2 cm diameter piece of the esophageal mucosa. Multiple excisions can be performed in a piecemeal fashion to excise larger areas of Barrett’s esophagus. Endoscopic submucosal dissection can be used to excise larger areas en bloc. However, endoscopic submucosal dissection is operator-dependent, and has a longer learning curve than endoscopic mucosal resection. Hence, it is less commonly applied in the context of Barrett’s esophagus.
Esophageal Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Jennifer Kahan, Carys Morgan, Kieran Foley, Thomas Crosby
Endoscopic treatment options such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) may be the preferred management of T1a disease. These were originally used in the management of premalignant disease such as high-grade dysplasia but are also well-tolerated and effective treatments for superficial early esophageal malignancy.56 Circumferential EMR should be carefully considered, as there is a high incidence of stricture formation. EMR: Endoscopic mucosal resection EMR is an endoscopic approach in which the neoplastic epithelium is excised, thus allowing a definitive histologic diagnosis.Techniques may involve submucosal injection to separate mucosal and submucosal lesions from the muscularis propria and then suctioning to lift and cut the lesion.There are various indications, including dysplastic Barrett’s and early esophageal cancers (T1a) as well as large bowel lesions such as sessile colonic neoplasms.ESD: Endoscopic submucosal dissection A specialist endoscopy technique that uses a modified needle knife (ESD-knife) to remove the lesion by dissecting through the submucosa, thus removing mucosal and submucosal tumors en bloc irrespective of the size of the lesion.ESD has been found to improve en bloc curative resection and local recurrence rates compared with EMR but was more time-consuming and had higher rates of bleeding and perforation complications.57,58 Indications include tumors of the upper GI tract, from the esophagus to the duodenum.Radiofrequency ablation A bipolar electrode is used to ablate areas of dysplasia.Highly effective in ablating Barrett's mucosa and associated dysplasia and in preventing progression of disease.Does not have the same risks as photodynamic therapy and argon plasma coagulation, which are associated with esophageal stenosis and sub-squamous foci of Barrett’s esophagus (“buried Barrett’s”).49,50
Efficacy of endoscopic ultrasound and endoscopic resection for esophageal schwannoma
Published in Scandinavian Journal of Gastroenterology, 2023
Jiao Jiao, Xiaofei Fan, Lili Luo, Wei Zhao, Zhongqing Zheng, Xin Chen, Tao Wang, Bangmao Wang, Wentian Liu
All endoscopic submucosal dissection (ESD) operations were performed under general anesthesia with tracheal intubation and continuous cardiorespiratory monitoring. The patient was placed in the left decubitus position. ESD endoscopic surgical procedures were as follows. (1) The location of the esophageal eminence lesion was determined under gastroscopy (Figure 2(A)). (2) An APC device was used to mark the boundary of the lesion. A mixed solution of saline, indigo carmine, and epinephrine was locally injected into the submucosa to make a cushion (Figure 2(B)). (3) A hook knife was used to cut through the mucosal layer along the marker. The hook and insulated tip knives were used to separate the lesion layer by layer alternately along the submucosa (Figure 2(C–D)). (4) Complete dissection of esophageal submucosal lesions was conducted (Figure 2(E)). (5) The wound was treated with electrocoagulation and closed with endoclips. The specimens were submitted for examination (Figure 2(F)).
Complete endoscopic removal rate of detected colorectal polyps in a real world out-patient practical setting
Published in Scandinavian Journal of Gastroenterology, 2023
Seitaro Shimada, Kinichi Hotta, Kazunori Takada, Kenichiro Imai, Sayo Ito, Yoshihiro Kishida, Noboru Kawata, Masao Yoshida, Yoichi Yamamoto, Yuki Maeda, Tatsunori Minamide, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, Hiroyuki Ono
In this study, the clean colon rate was 95.1% per patient, and 97.0% per lesion in a single-session colonoscopy. Significant factors of clean colon failure were inadequate bowel preparation, five or more polyps and adenocarcinoma, in multivariate analysis. As to polyp resection technique, cold polypectomy using forceps or snare accounted for 85% of all target lesions ≤20 mm. We believe that our investigation provides the first report of detailed data for the complete resection rate of all detected lesions in single-session colonoscopy. We analyzed the percentage of endoscopic complete removal of colorectal polyps among detected endoscopic neoplastic polyps. Therefore, IBD and FAP patients with backgrounds that could not be extrapolated to the general population to were excluded from this study. Moreover, neoplastic lesions requiring subsequent endoscopic resection, such as endoscopic submucosal dissection, were also excluded.
Colorectal cancer surveillance with chromoendoscopy in inflammatory bowel disease: results from a real-life experience
Published in Scandinavian Journal of Gastroenterology, 2021
Cristina Rubín de Célix, María Chaparro, José Andrés Moreno, Cecilio Santander, Javier P. Gisbert
As for the resection method, in some cases patients with IBD present submucosal fibrosis as a result of the chronic inflammation associated with IBD. This complicates endoscopic resection by common polypectomy techniques [18]. The optimal endoscopic technique depends on the type of lesion. For non-polypoidal morphology dysplastic lesions or for lesions that are larger than 20 mm, endoscopic mucosal resection is not suitable due to the high risk of performing a fragmented resection. Thus, endoscopic submucosal dissection poses some advantages against endoscopic mucosal resection, since it allows block resections and it avoids colectomies in selected patients [19]. Of the 186 chromoendoscopies carried out in our center, an endoscopic submucosal dissection was performed in one of the lesions located in the rectum, which showed a HGD in the histological analysis and did not relapse during the endoscopic follow-up. There already are a series of cases which show evidence of the effectiveness and safety of the endoscopic submucosal dissection, as it was the case with our patient, with up to 70–100% of resections not showing microscopic nor macroscopic evidence of tumoral tissue [20,21]). However, most lesions identified during our screening period were small lesions that were resected effectively by common polypectomy techniques, which suggest chromoendoscopy is an accessible screening method in our environment.