ASGE Esophagology: Tailoring Management from Testing to Treatment (Live and Virtual) | July 2022-Wang_Endoscopic Resection Techniques in Esophagus

Wang_Endoscopic Resection Techniques in Esophagus

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Endoscopic resection is a procedure used to remove abnormal tissue in the esophagus, specifically in cases of Barrett's esophagus. The primary goal of this procedure is to improve histology and staging of the condition. The selection of the appropriate resection method depends on the characteristics of the lesion, such as its size and appearance. Endoscopic Mucosal Resection (EMR) is commonly used for smaller lesions, while Endoscopic Submucosal Dissection (ESD) is preferred for larger lesions or those suspected to be malignant.<br /><br />EMR is a safe procedure with low risk of complications, such as perforation and bleeding. However, there is a higher risk of strictures with EMR. ESD, on the other hand, requires more experience and carries a higher risk of complications, especially in cases of submucosal fibrosis.<br /><br />The presence of fibrosis can affect the success of ESD and increase the risk of perforation and bleeding. Studies have shown that higher grades of fibrosis are associated with lower rates of complete resection and higher rates of complications. The choice of ESD knives, such as scissor-type knives, can influence the safety and outcomes of the procedure.<br /><br />In cases where EMR has been previously performed, it is not associated with higher levels of fibrosis. However, prior thermal ablative therapy is associated with fibrosis. F2 fibrosis is associated with a higher rate of complications during ESD.<br /><br />In summary, endoscopic resection is a valuable technique for removing abnormal tissue in Barrett's esophagus. It allows for a more accurate assessment of histology and depth of invasion, as well as margin assessment. EMR and ESD are the main resection methods used, depending on the characteristics of the lesion. Fibrosis can complicate ESD and increase the risk of complications. Careful consideration and experience are necessary when performing endoscopic resection in these cases.

Keywords

endoscopic resection

Barrett's esophagus

histology

lesion characteristics

EMR

ESD

complications

perforation

bleeding

fibrosis