Endoscopy: From Diagnosis to Therapeutics
Two decades ago, gastroenterologists used endoscopy for the diagnosis
of Gastrointestinal lesions, thereby helping surgeons to localize
lesion that necessitated resection and treatment with surgery.
Today, the gastroenterology field has advanced beyond
the diagnostic era a nd now, a large number of GI lesions
can be treated via endoluminal procedures performed
by the gastroenterologist with no need for surgical intervention.
In recent years, the improvement of endoscopic imaging
and tools, such as snares, clips and needles which can be
delivered through the endoscope channel,
have helped to change the field of gastroenterology.
This allowed for the development and advancement
of Endoscopic Mucosal Resection and Endoscopic
Submucosal Dissection.
One system is the Japanese classification
and the second is the Paris system,
which was proposed in 2002.
Endoscopic ultrasound may be useful in deciding
whether to perform EMR or ESD.
Once removal of the lesion is complete,
tattooing of the procedure
area can be considered in order
to assist in surveillance.
Use of India ink tattooing is recommended,
but careful injection is necessary
as India ink can result in tissue
scarring if injected to the submucosal space.
The long term outcomes of both EMR and ESD have
been positive. Merkow, et al. compared the outcomes of patients
with early esophageal cancer treated by EMR or surgery.
There was a higher 30 day mortality rate in the surgical group and
year survival was 77% and 88% in the EMR and surgical groups respectively.
EMR for gastric lesions has also had favorable outcomes.
The outcomes of colonic EMR for early colon cancer are
similar to the results in esophageal and gastric EMR.
Endoscopy: From Diagnosis to Therapeutics
Gastro Open J. 2015; 1(2): e1-e3. doi: 10.17140/GOJ-1-e001
