The Optimal Technique to Remove Visible Lesions in Barrett’s Esophagus: When to Use Endoscopic Mucosal Resection or Endoscopic Submucosal Dissection?

Is Complete Endoscopic Resection Still a Viable Option for Barrett’s-Related Dysplasia and Neoplasia?

AGA Clinical Practice Update on the Utility of Endoscopic Submucosal Dissection in T1b Esophageal Cancer: Expert Review

Intraluminal Endoscopic Surgery: The Scioto Returns

Carving Out a Place for Endoscopic Submucosal Dissection

Are We Ready to Embrace Endoscopic Submucosal Dissection as the Organ-Sparing, Minimally Invasive Endoscopic Surgical Procedure of Choice for Large Colorectal Adenomas and Early Cancers?

AGA Institute Clinical Practice Update: Endoscopic Submucosal Dissection in the United States

Endoscopic Mucosal Resection: Not Your Father's Polypectomy Anymore

Submucosal fluid cushion and EMR: who rules the roost?

Background IBD patients have an increased risk of reporting a colorectal cancer. According to SCENIC, endoscopic resection (ER) should be preferred to biopsies for visible precancerous lesions in absence of stigmata of invasive cancer or submucosal fibrosis. However, the evidence is still lacking on specific outcomes of ER for the management of dysplastic lesions in IBD. Aim of this study was to evaluate the effectiveness and safety of ER of visible precancerous lesions in IBD patients. Methods In this retrospective study, we included consecutive IBD patients referred to an Endoscopy Unit (2016-2022) to undergo a ER, including endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD) and hybrid EMR-ESD (hESD), of visible precancerous lesions. The primary outcome was the assessment of rates of en bloc resection, R0 resection and adverse events (AEs). The secondary outcome was the rate of post-ER surgery and surgery for refractory IBD. En bloc resection was defined as excision of the targeted lesion in a single specimen. R0 resection was defined as resection with lateral and deep margins free of dysplasia/neoplasia on histopathology. Among AEs, we considered bleeding and perforation. Results A total of 67 visible lesions (64.18% non-polypoid, 53.73% left-side colon, median size 25 mm±20 mm, 65.67% neoplastic pit-pattern) in 67 patients with colonic IBD (56.72% male, median age 58 yrs±15 yrs, 68.66% ulcerative colitis, median disease duration 160 months±98 months, 58.21% active disease) were included. ESD, hESD, and EMR was performed in 20.9%, 6%, and 73.1% of cases. The final histopathological diagnoses after ER were inflammatory polyp in 32.84%, SSL in 8.96%, LGD in 40.30%, HGD in 13.42%, adenocarcinoma in 2.99%, and squamous cell carcinoma in 1.49% of cases. Excluding inflammatory polyps, en bloc resection was achieved in 14/14(100%), 3/4(75%), and 15/27(55%) lesions in case of ESD, hESD, and EMR (ESD+hESD vs EMR p<0.05). R0 resection was achieved in 12/14(86%), 3/4(75%), and 15/27(55%) lesions in case of ESD, hESD, and EMR (ESD+hESD vs EMR p=0.05). AEs occurred in 21% (2 bleedings and 1 perforation), 0%, and 3% (1 perforation) of patients treated by ESD, hESD and EMR (ESD+hESD vs EMR p=N.S.). Post-ER surgery rate was 21%, 25%, and 3% for patients treated by ESD, hESD, and EMR. Surgery for refractory IBD rate was 7%, 0%, and 18% for patients treated by ESD, hESD, and EMR. Conclusion Our findings showed that ER (including ESD, hESD, and EMR) of visible precancerous lesions performed in a tertiary center might be considered feasible, safe and effective in IBD patients, despite the presence of submucosal fibrosis. These data should be confirmed in a wider IBD population referring from different specialized Endoscopy Units.

How to Perform a High-Quality Endoscopic Submucosal Dissection

Stomach: Endoscopic resection for early gastric cancer.

The difference in clinical outcomes after endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early Barrett's esophagus (BE) neoplasia remains unclear. We compared the recurrence/residual tissue rates, resection outcomes, and adverse events after ESD and EMR for early BE neoplasia. We included patients who underwent EMR or ESD for BE-associated high grade dysplasia (HGD) or T1a esophageal adenocarcinoma (EAC) at eight academic hospitals. We compared demographic, procedural, and histologic characteristics, and follow-up data. A time-to-event analysis was performed to evaluate recurrence/residual disease and a Kaplan-Meier curve was used to compare the groups. 243 patients (150 EMR; 93 ESD) were included. EMR had lower en bloc (43 % vs. 89 %; P < 0.001) and R0 (56 % vs. 73 %; P = 0.01) rates than ESD. There was no difference in the rates of perforation (0.7 % vs. 0; P > 0.99), early bleeding (0.7 % vs. 1 %; P > 0.99), delayed bleeding (3.3 % vs. 2.1 %; P = 0.71), and stricture (10 % vs. 16 %; P = 0.16) between EMR and ESD. Patients with non-curative resections who underwent further therapy were excluded from the recurrence analysis. Recurrent/residual disease was 31.4 % [44/140] for EMR and 3.5 % [3/85] for ESD during a median (interquartile range) follow-up of 15.5 (6.75-30) and 8 (2-18) months, respectively. Recurrence-/residual disease-free survival was significantly higher in the ESD group. More patients required additional endoscopic resection procedures to treat recurrent/residual disease after EMR (EMR 24.2 % vs. ESD 3.5 %; P < 0.001). ESD is safe and results in more definitive treatment of early BE neoplasia, with significantly lower recurrence/residual disease rates and less need for repeat endoscopic treatments than with EMR.

Is en bloc resection essential for endoscopic resection of GI neoplasia?

Making endoscopic submucosal dissection in the duodenum safer: Is it possible?

Underwater EMR without submucosal injection: Is less more?