Can gastroscopy treat disease in addition to diagnose it?
C Yes, with the advancement of technology, gastroscopy has long been more than a simple diagnostic tool, it is a great treatment tool for endoscopists
C There are many gastroscopic instruments that doctors can use to perform injections, resections, etc. It is like an extension of the doctor’s arm, so that some diseases no longer require open surgery and can be done under the gastroscope
C The most basic endoscopic treatments are polypectomy, hemostasis, and further, stenosis dilation, stent placement, foreign body removal, etc. The biggest advancement in recent years is the ability to remove large pieces of mucosa under the gastroscope, called EMR and ESD.
What are EMR and ESD?
C To understand these two minimally invasive endoscopic resection methods, it is important to first understand the structure of the gastric wall: from the inside out, the gastric wall is divided into a mucosal layer, a submucosal layer, a lamina propria layer, and a plasma layer.
C The submucosal layer is rich in blood vessels, nerves and lymphatic vessels, which is the main reason why metastasis may occur once the tumor grows to the submucosal layer.
C Another characteristic of the submucosa is that it is very loose and can be propped up by injecting liquid into it with a needle.
C EMR and ESD take advantage of this feature of the submucosa. The full name of EMR is endoscopic mucosal resection, and the full name of ESD is endoscopic submucosal dissection, when the submucosa is opened, EMR is like cutting polyps and removing the lesion piece by piece with a trap, ESD is using an electric knife to gradually free the lesion from the mucosa layer under the direct view of the gastroscope, and finally peel it off completely.
The biggest advantage of EMR is that the technical requirements are relatively simple, the disadvantage is that the whole lesion cannot be removed; the advantage of ESD is that the whole lesion can be removed, which is particularly important for pathological diagnosis, the relative disadvantage is that the endoscopic skills of the operator are relatively high, only a small number of endoscopists can be competent for such an operation.
What kind of lesions are suitable for EMR/ESD?
C mainly lesions in the mucosal layer of the gastric wall, such as precancerous lesions and early carcinomas, some submucosal masses and even masses in the intrinsic muscular layer can be removed by EMR/ESD as long as the size is appropriate
What are the advantages of endoscopic resection compared with traditional surgical resection?
C The greatest advantage of EMR/ESD is that it is minimally invasive. Because only the mucosa is locally removed, there is almost no effect on the systemic status, and in the absence of complications, the patient can resume eating and drinking within 24 hours after surgery and be discharged from the hospital in 3-4 days; at the same time, the integrity of the esophagus or stomach is preserved and there is no impact on its function.
Is the endoscopic resection method, safe?
C Overall, it is a proven treatment technique and is relatively safe for experienced and qualified endoscopists.
C The main complications, are bleeding and perforation. Usually bleeding can be stopped by gastroscopy. Most perforations can be closed with metal clips, but in a few cases, perforations require surgery to cure.
- When complications occur, the patient’s hospital stay may be prolonged.
If I choose to have an endoscopic resection, what should the patient and family be aware of?
C First of all, choose a general hospital with strong endoscopic skills. This is because EMR/ESD requires a high level of endoscopic skills from the operator; also, such treatment requires not only an endoscopist, but also a team of people including nurses, anesthesiologists, etc.
C Adequate communication with the doctor is required before treatment
C Hospitalization is required, usually for 5-7 days. In addition to gastroscopy, ultrasound endoscopy, electrocardiogram, chest X-ray, blood tests, and for older patients, echocardiogram and pulmonary function may also be required. Patients with hypertension should not use antihypertensive drugs containing “reserpine”, and aspirin should be stopped for more than 7 days.
C The pathology before surgery is the result of biopsy, which does not fully reflect the condition of the lesion, and the pathology after surgery is a large and complete specimen.
C After treatment, you should take medication according to the doctor’s requirements and review the gastroscopy regularly, usually once at 1-3 months, 6 months, 12 months after surgery, and once a year thereafter
What is the endoscopic tunneling technique?
C This is a new technique based on ESD, the simple procedure is to make a small incision in the mucosa, then the gastroscope is drilled through this incision into the submucosa and gradually separated to create a tunnel in the submucosa, the length of the tunnel is usually 5-15 cm depending on the need. after the treatment, the incision in the mucosa can be closed with a titanium clip to maintain the integrity of the mucosa
C This technique can be used to remove mesenchymal tumors from the intrinsic muscular layer of the esophageal wall, as well as to cut through the intrinsic muscular layer to relieve muscle spasm and treat cardia incontinentia.