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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 ...
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 lesion borders are marked with a coagulator. Highly concentrated saline and epinephrine are injected (15–20 ml) into the submucosal layer to swell the area containing the lesion and elucidate the markings. The mucosa outside the demarcated border is excised using a high-frequency scalpel to the depth of the submucosal layer.
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.
A gastrostomy can also be used to treat volvulus of the stomach, where the stomach twists along one of its axes. The tube (or multiple tubes) is used for gastropexy, or adhering the stomach to the abdominal wall, preventing twisting of the stomach. [2] A PEG tube can be used in providing gastric or post-surgical drainage. [6]
Cancer of the stomach is difficult to cure unless it is found at an early stage (before it has begun to spread). Unfortunately, because early stomach cancer causes few symptoms, the disease is usually advanced when the diagnosis is made. [80] Treatment for stomach cancer may include surgery, [81] chemotherapy, [13] or radiation therapy. [82]
Barium X-ray examinations are useful tools for the study of appearance and function of the parts of the gastrointestinal tract. They are used to diagnose and monitor esophageal reflux, dysphagia, hiatus hernia, strictures, diverticula, pyloric stenosis, gastritis, enteritis, volvulus, varices, ulcers, tumors, and gastrointestinal dysmotility, as well as to detect foreign bodies.