Frontiers in interventional endoscopy

Abstract

Digestive endoscopy, including endoscopic ultrasound, plays actually an important role in oncology concerning early diagnosis, tumor staging, and therapeutic procedures. Indeed, improvement of endoscope and dedicated accessories allow to increase applications of therapeutic endoscopy in oncologic indications : curative resection of early carcinoma ant submucosa tumor ; palliative treatment of tumoral bilio-digestive obstruction. Possibilities to resect sessile or flat polyps allow to treat curatively well-differentiated carcinoma without infiltration of the muscularis mucosae, the risk of lymph nodes invasion being null in this cases. In case of invasion of muscularis mucosae, this risk is inferior to 1% for colorectal cancer when submucosal invasion do not exceed 1000 microm but this risk is between 6 and 22% in case of oeso-gastric carcinoma invading the third part of the submucosa. Mortality of endoscopic resection was null in almost published series. Morbidity was 15-20% for colorectal resection with 5-6% of severe complications and up to 23% after oesophageal tumor ablation. Moreover, improvement of echoendoscope dedicated to therapeutic procedures allow from now to achieve non-anatomic pancreatic or biliary drainage through the gastric wall when the retrograde route is not suitable (whipple resection, duodenal stricture) or when drainage of the left hepatic lobe is difficult via the retrograde approach. The aim of this technique is to realize an anastomosis between the left hepatic duct and the stomach. Permanence of this fistula is ensured by insertion of one or two stent. Efficacy and safety of this procedure were recently retrospectively evaluated with a technical success in 91% of cases. Therapeutic endoscopy made many progress during the last years and development of new generation of endoscope and accessories would allow a real endoluminal surgical approach for superficial tumor, bilio-digestive anastomosis or gastro-enteroanastomosis by example.