Endoscopic mucosal resection in the upper gastrointestinal tract

Abstract

Endoscopic mucosal resection (EMR) is a technique used to locally excise lesions confined to the mucosa. Its main role is the treatment of advanced dysplasia and early gastrointestinal cancers. EMR was originally described as a therapy for early gastric cancer. Recently its use has expanded as a therapeutic option for ampullary masses, colorectal cancer, and large colorectal polyps. In the Western world, the predominant indication for EMR in the upper gastrointestinal tract is the staging and treatment of advance dysplasia and early neoplasia in Barrett's esophagus. This review will describe the basis, indications, techniques, and complications of EMR, and its role in the management of Barrett's esophagus.

Adverse events of upper GI endoscopy

“…The incidence of esophageal stricture after focal EMR is less than 0.5%, compared with an incidence of 12% to 35% when more than 50% of the esophageal circumference is resected. 145,147 Endoscopic submucosal dissection (ESD) allows for en bloc excision of large mucosal lesions of the GI tract by using a variety of specialized accessories. 148,149 Adverse events of ESD are similar to those of EMR, but occur with greater frequency given the larger areas of resection.…”

Clinical significance of the discrepancy between preoperative and postoperative diagnoses in gastric cancer patients

“…Endoscopic mucosal resection is commonly performed for differentiated gastric adenocarcinoma confined to mucosa, an elevated tumor 2 cm, and flat or depressed tumor 1 cm [17], although it has been argued that its indication criteria should be extended to include submucosal invasive gastric cancer [18,19]. Accordingly, accurate preoperative diagnosis is becoming an increasingly important aspect of gastric cancer treatment.…”

Gastric Cancer Surgery: An American Perspective on the Current Options and Standards

“…While the majority of studies evaluating EMR as a diagnostic and therapeutic modality for gastric cancer have emerged from Japan and Korea, its utility in the U.S. population is slowly starting to be realized. • Indications for EMR in gastric cancer from the Japanese literature are tumors confined to the mucosa, size <2 cm for elevated lesions or <1 cm for flat lesions, moderately to well-differentiated pathology, absence of ulcer, and absence of lymph node involvement [31]. In the U.S., all lesions are classified according to the AJCC staging classification, which is based on tumor size or depth of infiltration (T), nodal status (N), and the presence of metastatic disease (M).…”

“…Endoscopic submucosal dissection • Endoscopic submucosal dissection (ESD) has also been developed as a more locally aggressive technique involving a more extensive dissection, generally with an electrocautery knife [31]. …”