Endoscopic mucosal resection is a novel technique that allows the endoscopist to diagnose and initiate appropriate therapy for superficial gastrointestinal cancers. The technique improves diagnosis by reliably removing tissue to the depth of the submucosa, which is not usually achieved by standard endoscopic biopsy. The depth of resection permits the diagnosis of submucosal tumors or dysplasia-associated lesions or mass lesions that have been difficult to diagnose. The technique also removes greater quantities of tissue that allows histologic assessment of the completeness of mucosal resection. Areas of tissue as large as 1 to 4 cm in diameter have been removed using this technique, which allows the endoscopist to completely excise small tumors with an intention to cure the patient. There have been several publications that indicate that this technique may be used to treat early cancers of the esophagus, stomach, and colon with 60% to 85% "cure" rates. The technique can be applied by 3 different methods. The first is a "strip biopsy" technique that combines a forcep and snare placed through a dual-channel therapeutic endoscope. The forcep is used to draw the tissue into the snare for tissue excision. A "suck" technique can also be used by which tissue is suctioned into a cap fitted onto the endoscope. A snare has been fitted around the outside of the cap before application of the suction. The snare can then be closed around the tissue that has been suctioned into the cup. This "suck" technique can be further modified with a variceal ligating device to create an artificial polyp that can subsequently removed with a snare. Finally, the tissue can be cut with an insulated diathermic knife to initially circumscribe the lesion, which is then easy to remove. Any of these techniques can be used for tissue removal safely with equipment that is available to most endoscopists.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging