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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.
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]
Prior to resection, assessment of the polyp should include: polyp size, morphology, location, and accessibility. [3] If there are features that suggest of cancer is present in the polyp, then either endoscopic submucosal dissection or surgery should be considered. [3]
A diagram of a local resection of early stage colon cancer A diagram of local surgery for rectal cancer Margins of a colonic resection. At an early stage, colorectal cancer may be removed during a colonoscopy using one of several techniques, including endoscopic mucosal resection or endoscopic submucosal dissection. [5]
Endoscopic mucosal resection involves removal of the mucosal layer, and in order to be done safely, a submucosal injection of dye is performed to ensure integrity at the beginning of the procedure. Female uterine submucosal layers are liable to develop fibroids during pregnancy and are often excised upon discovery. [1]
Several endoscopic findings have been reported, including solitary ulcers, thickened gastric folds, mass lesions and nodules. As there may be infiltration of the submucosa, larger biopsy forceps, endoscopic ultrasound guided biopsy, endoscopic submucosal resection, or laparotomy may be required to obtain tissue.
Most reports in the literature describe local surgical resection of Brunner gland hamartoma via duodenotomy. Increasingly, successful endoscopic resection has been reported and is primarily used for pedunculated Brunner gland hamartomas. The endoscopic approach in selective cases appears to be safe, less invasive, and less costly. [citation needed]
Endoscopic submucosal dissection is a similar technique pioneered in Japan, used to resect a large area of mucosa in one piece. [6] If the pathologic examination of the resected specimen shows incomplete resection or deep invasion by tumor, the patient would need a formal stomach resection.