Advances in endoscopic resection: a review of endoscopic submucosal dissection (ESD), endoscopic full thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER)

Abstract

Subepithelial lesions are often detected incidentally in patients undergoing an endoscopy. They are common tumors of the gastrointestinal (GI) tract which can originate from different layers of the GI tract wall. These lesions can be further classified based on GI layer of origin and unique histochemical staining. While most are benign and asymptomatic, some of these lesions have malignant potential with distant metastases. However, current diagnostic modalities including endoscopy with biopsy or endoscopic ultrasound with fine needle aspiration are not always reliable. In addition, management of these lesions has historically involved surgical resection via open or laparoscopic approaches. In recent years, with advancement in endoscopic techniques and improvement in endoscopists' skills, less invasive procedures such as endoscopic submucosal dissection (ESD), endoscopic full thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER) have been developed and now are being used by endoscopists worldwide. Upon reviewing the literature, multiple studies have shown the advantages of these endoscopic techniques when compared with surgical treatment. As a result, there has been a dramatic shift towards minimally invasive endoscopic procedures for the management of these subepithelial lesions. In this review article, we will discuss these endoscopic resection techniques in detail, their safety and efficacy, as well as comparison studies to other therapeutic modalities.

Novel Sequence of Endoscopic Therapy for the Management of Colonic Adenocarcinoma and Surrounding Adenoma

“… 1 , 3 Over-the-scope clip-assisted EFTR has been deemed suitable for lesions that are <2 cm in the colorectum. 5 One multicenter prospective study demonstrated that the FTRD device had an overall technical efficacy of 89.5% and an R0 resection rate of 76.9%. 6 In this study, lesions <2 cm had an R0 rate of 81.2% while lesions >2 cm had an R0 rate of 58.11%.…”

Efficacy and histologic frequencies of endoscopic ultrasonography‐guided tissue acquisition using conventional fine‐needle aspiration needles for gastric subepithelial hypoechoic mass

“…Submucosal tunnelling endoscopic resection (STER), which has become a popular endoscopic treatment (en-bloc resection) recently, can be applied to small subepithelial tumours (<2 or 3 cm) originating from the muscularis propria, such as schwannoma, leiomyoma, and GIST. [30][31][32] Submucosal tunnelling endoscopic resection is reported to be effective (en-bloc resection rate: 94.6%), less invasive, and has a low risk of adverse events (prevalence of perforation: 5.6%) because tumour resection is performed endoscopically in the submucosal tunnel (artificial submucosal space) without a surgical approach. 33 Submucosal fibrosis caused by MIAB makes STER difficult, as it could cause tunnel damage, thus inducing perforation.…”

Submucosal tunneling endoscopic full-thickness resection for management of a rare case of esophageal GI stromal tumor

“…Endoscopic submucosal dissection is an established minimally invasive procedure for the removal of GI premalignant and malignant lesions, with potential for detailed pathologic evaluation. 1 , 2 Submucosal tunneling endoscopic resection (STER) is a well-established technique within the field of endoscopic submucosal dissection that involves tunnel-exposed, endoscopic full-thickness resection for lesions originating from different layers of the GI tract wall. 3 …”

“…Esophageal GISTs account for less than 1% of all GISTs. 2 , 4 , 5 Until recently, treatment options included surveillance, surgical resection, tyrosine kinase inhibitor (TKI), and imatinib, depending on the extent of disease and tumor sensitivity to TKI. 2 , 4 , 6 The advances in third-space endoscopy have led to the development of peroral endoscopic tunnel resection (POET) for the management of submucosal tumors.…”