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Endoscopic submucosal dissection (ESD) is an advanced surgical procedure using endoscopy to remove gastrointestinal tumors that have not entered the muscle layer. ESD may be done in the esophagus, stomach or colon. Application of endoscopic resection (ER) to gastrointestinal (GI) neoplasms is limited to lesions with no risk of nodal metastasis.
The lesion appears submucosal, is hypervascular and protrudes intraluminally. Upper GI bleeding led to endoscopy, finding an ulcerated mass. Non-enhanced CT image of a small GIST in the posterior stomach wall (arrow). The lesion appears subserosal. Incidental finding. Plain radiographs are not very helpful in the evaluation of GISTs. If an ...
The gastric folds (or gastric rugae) are coiled sections of tissue that exist in the mucosal and submucosal layers of the stomach. [1] They provide elasticity by allowing the stomach to expand when a bolus enters it. These folds stretch outward through the action of mechanoreceptors, which respond to the increase in pressure. [2]
Invasion of tumours through the layers of the gastrointestinal wall is used in staging of tumour spread. This affects treatment and prognosis. The normal thickness of the small intestinal wall is 3–5 mm, [6] and 1–5 mm in the large intestine. [7] Focal, irregular and asymmetrical gastrointestinal wall thickening suggests a malignancy. [7]
The submucosa (or tela submucosa) is a thin layer of tissue in various organs of the gastrointestinal, respiratory, and genitourinary tracts. It is the layer of dense irregular connective tissue that supports the mucosa (mucous membrane) and joins it to the muscular layer, the bulk of overlying smooth muscle (fibers running circularly within layer of longitudinal muscle).
Endoscopic mucosal resection and submucosal dissection are also highly effective methods for resection or large, non-malignant colorectal polyps and superficially (stage T1a) invasive colorectal cancers. The largest study of endoscopic mucosal resection by the Australian Consortium included 1000 cases and long term surveillance. [2]
Surgery, consisting of excision of part of the lower stomach, also called antrectomy, is another option. [6] [16] Antrectomy is "the resection, or surgical removal, of a part of the stomach known as the antrum". [2] Laparoscopic surgery is possible in some cases, and as of 2003, was a "novel approach to treating watermelon stomach". [26]
The per-oral endoscopic myotomy, or POEM, is a minimally invasive surgical procedure for the treatment of achalasia wherein the inner circular muscle layer of the lower esophageal sphincter is divided through a submucosal tunnel. [1] This enables food and liquids to pass into the stomach, a process that is impaired in achalasia.