Endoscopic Submucosal Dissection
Özet
Examining the importance, development, and efficacy of the Endoscopic Submucosal Dissection (ESD) technique in the diagnosis and treatment of gastrointestinal superficial lesions alongside a comparison with Endoscopic Mucosal Resection (MR), this study provides critical data for early-stage cancer treatment. Colorectal and gastric cancers exhibit high incidence and mortality rates globally, yet they can be treated with less invasive methods when detected at an early stage. While the EMR technique offers effective treatment for lesions smaller than 20 mm, it does not allow for a complete histological evaluation or complete resection of larger, ulcerated, or complex lesions carrying a suspicion of submucosal invasion. The ESD technique overcomes these limitations by providing a holistic (en-bloc R0) excision regardless of the tumor size, thereby reducing local recurrence rates and enabling accurate pathological staging. According to the European Society of Gastrointestinal Endoscopy (ESGE) guidelines, ESD is recommended as the preferred treatment for superficial esophageal squamous cell carcinomas, gastric superficial neoplastic lesions, and colorectal lesions larger than 20 mm with suspected limited submucosal infiltration. However, this technically demanding procedure requires extensive knowledge, high skill levels, and specialized training, carrying longer operative times and a higher risk of complications like perforation and bleeding compared to EMR. Conversely, due to high perforation rates, its routine use in the small intestine and duodenum is not advised. Consequently, ESD serves as a highly capable, minimally invasive alternative to surgery, ensuring shorter hospital stays and lower costs.
Referanslar
https://www.iarc.who.int/wp-content/uploads/2018/09/pr263_E.pdf
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