Arthur Hoffman1, Raja Atreya2,3, Timo Rath2,3, Markus Ferdinand Neurath2,3. 1. Department of Internal Medicine III, Aschaffenburg-Alzenau Clinic, Aschaffenburg, Germany. 2. First Department of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany. 3. Deutsches Zentrum Immuntherapie, DZI, Erlangen, Germany.
Abstract
BACKGROUND: Endoscopic resection of dysplastic lesions in early stages of cancer reduces mortality rates and is recommended by many national guidelines throughout the world. Snare polypectomy and endoscopic mucosal resection (EMR) are established techniques of polyp removal. The advantages of these methods are their relatively short procedure times and acceptable complication rates. The latter include delayed bleeding in 0.9% and a perforation risk of 0.4-1.3%, depending on the size and location of the resected lesion. EMR is a recent modification of endoscopic resection. A limited number of studies suggest that larger lesions can be removed en bloc with low complication rates and short procedure times. Novel techniques such as endoscopic submucosal dissection (ESD) are used to enhance en bloc resection rates for larger, flat, or sessile lesions. Endoscopic full-thickness resection (EFTR) is employed for non-lifting lesions or those not easily amenable to resection. Procedures such as ESD or EFTR are emerging standards for lesions inaccessible to EMR techniques. SUMMARY: Endoscopic treatment is now regarded as first-line therapy for benign lesions. KEY MESSAGE: Endoscopic resection of dysplastic lesions or early stages of cancer is recommended. A plethora of different techniques can be used dependent on the lesions.
BACKGROUND: Endoscopic resection of dysplastic lesions in early stages of cancer reduces mortality rates and is recommended by many national guidelines throughout the world. Snare polypectomy and endoscopic mucosal resection (EMR) are established techniques of polyp removal. The advantages of these methods are their relatively short procedure times and acceptable complication rates. The latter include delayed bleeding in 0.9% and a perforation risk of 0.4-1.3%, depending on the size and location of the resected lesion. EMR is a recent modification of endoscopic resection. A limited number of studies suggest that larger lesions can be removed en bloc with low complication rates and short procedure times. Novel techniques such as endoscopic submucosal dissection (ESD) are used to enhance en bloc resection rates for larger, flat, or sessile lesions. Endoscopic full-thickness resection (EFTR) is employed for non-lifting lesions or those not easily amenable to resection. Procedures such as ESD or EFTR are emerging standards for lesions inaccessible to EMR techniques. SUMMARY: Endoscopic treatment is now regarded as first-line therapy for benign lesions. KEY MESSAGE: Endoscopic resection of dysplastic lesions or early stages of cancer is recommended. A plethora of different techniques can be used dependent on the lesions.
Authors: Marc O Schurr; Franziska E Baur; Martina Krautwald; Marion Fehlker; Manfred Wehrmann; Thomas Gottwald; Ruediger L Prosst Journal: Surg Endosc Date: 2014-10-16 Impact factor: 4.584
Authors: Roos E Pouw; Frederike G I van Vilsteren; Femke P Peters; Lorenza Alvarez Herrero; Fiebo J W Ten Kate; Mike Visser; Boudewijn E Schenk; Erik J Schoon; Frans T M Peters; Martin Houben; Raf Bisschops; Bas L A M Weusten; Jacques J G H M Bergman Journal: Gastrointest Endosc Date: 2011-07 Impact factor: 9.427