Endoscopic Resection Techniques for Gastrointestinal Neoplasia
Summary
Endoscopic resection has transformed the management of early gastrointestinal neoplasia by offering organ-preserving alternatives to surgery. Two principal approaches dominate clinical practice: endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). EMR employs injection of fluid beneath a lesion followed by snare resection, and is particularly suited to small or raised lesions. ESD, by contrast, uses specialised knives to dissect the submucosal layer and achieve en bloc removal of larger or ulcerated neoplasms. This enables precise histological assessment of margins and depth of invasion, reducing recurrence rates. Recent innovations focus on optimising submucosal injection fluids to sustain a lasting cushion, refining traction methods to improve exposure of the dissection plane, and developing closure devices to reduce adverse events. Cold snare techniques have also emerged for diminutive polyps, minimising thermal injury. Collectively, these refinements expand the scope of endoscopic therapy, enhance procedural safety and efficacy, and support the global shift towards minimally invasive management of early gastrointestinal cancers.
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Endoscopic Resection Techniques for Gastrointestinal Neoplasia publication trend
The graph below shows the total number of articles in endoscopic resection techniques for gastrointestinal neoplasia across all publications each year (not limited to Nature Index journals).
Technical terms
Endoscopic mucosal resection (EMR): A technique that injects fluid beneath a superficial lesion and removes it en bloc or piecemeal with a snare.
Endoscopic submucosal dissection (ESD): An advanced procedure using specialised knives to dissect the submucosal layer for en bloc removal of larger gastrointestinal neoplasms.
Submucosal injection (cushion): The instillation of fluid or gel into the submucosal space to lift and separate the lesion from the muscularis propria.
En bloc resection: The removal of a lesion in one piece to ensure complete pathological assessment of margins.
Counter traction: A method of applying tension to the lesion or surrounding mucosa to improve exposure of the submucosal dissection plane.
References
- Endoscopically Injectable Shear‐Thinning Hydrogels Facilitating Polyp Removal. Advanced Science (2019).
- Novel effective and repeatedly available ring-thread counter traction for safer colorectal endoscopic submucosal dissection. Surgical Endoscopy (2016).
- Efficacy and safety of 0.6% sodium alginate solution in endoscopic submucosal dissection for esophageal and gastric neoplastic lesion: A randomized controlled study. Digestive Endoscopy (2019).
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