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

Wang_Endoscopic Resection Techniques in Esophagus

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This document discusses the use of endoscopic resection in Barrett's esophagus, a condition characterized by the presence of abnormal cells in the lining of the esophagus. The goals of endoscopic resection are to improve histology and staging, as well as eliminate high-grade dysplasia. The document presents a case study of a 72-year-old patient with iron deficiency anemia and Barrett's esophagus. The lesion in the esophagus is described as having irregular mucosal and vascular patterns, indicating high-grade dysplasia.<br /><br />The document provides a simple classification for selecting the appropriate method of resection based on the characteristics of the lesion. It discusses the pros and cons of endoscopic mucosal resection (EMR), highlighting improvements in pathology agreement and the elimination of high-grade dysplasia, but also noting the potential risks of the procedure such as bleeding and strictures. Complications of EMR are discussed, including bleeding and strictures, with reported rates ranging from 1-2.5%.<br /><br />Another case study is presented involving a 68-year-old patient with a GE junctional mass and a history of radiofrequency ablation for Barrett's esophagus. The lesion is found to be non-lifting, indicating adherence or invasion of the esophageal wall. The document discusses the different methods of resection, including piecemeal EMR, full-thickness resection, and endoscopic submucosal dissection (ESD). The risks and benefits of each method are discussed, with a focus on the increased risk of complications with fibrosis present in the submucosal layer.<br /><br />The document concludes by summarizing the key points, including the rationale for endoscopic resection, the appropriate method of resection based on lesion characteristics, and the anticipated complications. It emphasizes the importance of en bloc resection for potential neoplastic lesions, improved interpretation of histology and depth of invasion, and assessment of margins. It also highlights the caution needed when dealing with non-lifting lesions due to fibrosis, as they carry an increased risk of bleeding and perforation.

Keywords

endoscopic resection

Barrett's esophagus

high-grade dysplasia

lesion

EMR

bleeding

strictures

fibrosis

neoplastic lesions

perforation