Gastroscopic resection (EMR/ESD, mucosal resection, mucosal peeling)
Can gastroscopy diagnose disease, but also cure it?
Yes, with the advancement of technology, gastroscopy has long been more than a simple diagnostic tool, it is an excellent treatment tool for endoscopists.
There are many gastroscopy-specific 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.
The most basic endoscopic treatments are polypectomy, hemostasis, and furthermore, 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?
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.
The submucosa contains rich blood vessels, nerves and lymphatic vessels, which is the main reason why metastasis may occur once the tumor grows to the submucosa.
The submucosa has another feature, that is, it is very loose, so by injecting liquid into it with a needle, the submucosa can be propped up EMR and ESD are using this feature of the submucosa. is to use an electric knife to gradually free the lesion from the mucosal layer under the direct view of the gastroscope, and finally peel it off completely.
The biggest advantage of EMR is that it is relatively simple in terms of technical requirements, and the disadvantage is that the lesion cannot be removed in one piece; the advantage of ESD is that the lesion can be removed in one piece, which is especially important for pathological diagnosis, but the relative disadvantage is that the endoscopic technique of the operator is relatively high, and only a small number of endoscopists can be competent for such an operation.
What kind of lesions are suitable for EMR/ESD?
Some submucosal masses and even intrinsic muscle masses can be removed by EMR/ESD as long as they are of appropriate size. What are the advantages of endoscopic resection compared to traditional surgical resection?
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 can be discharged 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?
Overall, it is a proven treatment technique that is relatively safe for experienced and qualified endoscopists.
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?
First, choose a general hospital with strong endoscopic techniques. 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.
It is important to have adequate communication with the doctor before treatment.
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 be required. Patients with hypertension should not use antihypertensive drugs containing “reserpine”, and aspirin should be stopped for more than 7 days.
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.
After treatment, it is important to take medication as required by the doctor and to review the gastroscopy regularly, usually once at 1-3 months, 6 months, 12 months, and then once a year after the surgery.
What is the endoscopic tunneling technique?
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, which is usually 5-15 cm in length depending on the need. at the end of the treatment, the incision in the mucosa can be closed with a titanium clip to maintain the integrity of the mucosa.
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.