The Next Endoscopic Frontier: Resection Endoscopy

Resection in the medical field refers to the procedure of removing tissue or part or all of an organ, and resection endoscopy usually involves removing abnormal tissues using an endoscope. According to ACG Case Reports Journal: January 2021, resection endoscopy, which was pioneered in Asia, is currently spreading swiftly within western countries. It is highly efficient in preventing cancer and its spreading, as it provides a method that can spare the cost, morbidity, and mortality of surgery to remove precancerous and early-stage cancer tissues.

Below are 3 interventional endoscopy procedures that the case report mentioned, with a more in-depth definition sourced from Johns Hopkins Medicine’s website.

1. Endoscopic Mucosal Resection (EMR)

EMR is an outpatient procedure in which physicians remove tumours just beneath the gastrointestinal (GI) wall without surgery. EMR is most effective for tumours that have not yet reached deeper layers of the GI wall and are larger than 2 centimetres. EMR can treat conditions such as Barrett’s esophagus, precancerous or superficial cancerous tumours such as gastric or small bowel lesions (areas of abnormal tissue) and also early-stage esophageal cancer or colon cancer.

2. Endoscopic Submucosal Dissection (ESD)

ESD is an outpatient procedure to remove deep tumours from the GI tract. In some cases, ESD is a more effective option than EMR for removing growths or tumours. ESD may treat Barrett’s esophagus, early-stage cancerous tumours or colon polyps, tumours of the esophagus, stomach or colon that have not yet entered the deeper layer of the GI wall, with minimal or no risk of cancer spreading, and staging of cancer (determining the cancer level) to develop treatment plans.

3. Endoscopic Full Thickness Resection (EFTR)

EFTR is an outpatient procedure to remove growths deep in the wall of the gastrointestinal (GI) tract. EFTR is very effective for removing tumours located deep in the GI wall. Because of the location of these growths, other procedures could cause complications, such as tearing or perforation of tissue. It is more effective than EMR or ESD for safely removing tumours in the shallow layers of the GI wall that adhere to the muscle layer. In addition to deep tumours, physicians may use EFTR for GI bleeding, postsurgical complications such as a perforation (tear). stomach, small bowel or colon polyp removal (polypectomy), and closing holes or openings between organs or tissues (chronic fistula).

The case report also indicated that the adoption of ESD and EFTR in western countries has been very limited due to population differences in GI cancers, longer procedure times with associated costs, and lack of established training programs. However, in recent years, the discrepancy in performing these procedures has started to close with small groups of Western endoscopists learning and advocating for ESD with the aid of Asian experts. We are now entering an era where Western trainees are starting to develop interest and learn to resection endoscopic techniques without having to travel abroad.