GI cancers usually originate in the inner lining / mucosa and then spread to the surrounding lymph glands and organs. Oesophagus, stomach, duodenum, rectum and colon growths are accessible by the endoscope, and if picked up early, can be treated with just endoscopic resection. This decision is usually taken after the staging investigations are done, and prescribed for early cancerous lesions with out any lymph node spread. Endoscopic resection leads to organ preservation, and can be carried out as day case procedure. The two most adopted methods are:
In this procedure, depending on the lesion (Upper Gastrointestinal – esophagus/ stomach/ duodenum vs. Lower Gastrointestinal – rectum/ colon), the endoscope is introduced via the orifice to the target area. Using specialised instruments, the doctor can delineate the lesion and dissect it off from the underlying layers of the bowel. The resected area is checked for any signs of bleeding, and the resected specimen is sent for histopathology. Some of the lesions that can be resected via this method are:
One of the risks of carrying out ESD/ EMR is the risk of making a hole in the bowel during the procedure. This is usually managed with applying clips through the endoscope, or if challenging, the endoscopic surgeon can suture the hole by doing a laparoscopic surgery. This is known as Combined LECS (Laparoscopy and Endoscopy Cooperative Surgery), and can be carried out in the same setting as the endoscopic surgery.
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