Endoscopic resections for cancerous and precancerous lesions (polyps)

Advanced endoscopic (surgical) resections are a set of procedures that focus on the treatment of common diseases of the gastrointestinal tract, which include removal of polyps, removal of neoplasms and even exit from the gastrointestinal tract.
Following improvements in endoscopic instrumentation and the development of innovative techniques, endoscopic therapy allows for more accurate diagnosis of the disease, leads to excellent long-term results and is a cheaper, high-quality and safer substitute compared to traditional surgery.

Advanced endoscopy, more complex than regular endoscopy, requires specific experience and study, so it is performed in the hospital by a team trained in this type of operation.
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• Treatment of precancer/cancerous lesions of the gastrointestinal mucosa

• Treatment of tumors of the gastrointestinal mucosa
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Treatments for precancer/cancerous lesions (including polyps) in the gastrointestinal tract.

Most often the initial diagnosis of precancer/cancerous lesion of the gastrointestinal mucosa will be carried out outside the hospital during an endoscopic examination. After preliminary processing of all data, the doctor directs the further treatment to the hospital. We accept the referrals, review the data, summon the patient to action after providing detailed explanations.

Careful endoscopic evaluation before resection of both the upper and lower gastrointestinal tract is necessary for the correct determination of therapeutic astragia and the selection of the most appropriate endoscopic or surgical technique. We carry out this assessment before the operation using the most advanced optical technologies, which allow us to estimate the degree of lesion differentiation and the risk of the presence of invasive cancer with an accuracy of up to 90%.

After evaluation, further treatment of the lesion will be carried out by one of the three possible options: ESD, EMR or surgery.

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ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD)

ESD - endoscopic visualization of submucous membranes.

Advanced endoscopic method (which was developed in Japan) for excision of lesions from the mucosa of the gastrointestinal tract. This operation allows deep endoscopic excision of large polyps suspected to be malignant and tumors in the early stages. According to preliminary endoscopic diagnosis without the need for surgery or additional treatment. ESD allows complete excision of superficial tumors in the gastrointestinal tract, without limitation in the size of the lesion.

Such operations are carried out by experienced gastroenterologists with invasive endoscopy, having undergone only appropriate training.

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ENDOSCOPIC MUCOSAL RESECTION (EMR)

EMR - endoscopic resection of the mucosa.

The main use of this technique is in the large, thin intestine for excision of polyps larger than 20 mm. By the method EMR It is possible to remove polyps of any size, which do not have characteristics that suspect a malignant involvement of the polyp.

IN ADDITION, IN SOME CASES THIS TECHNIQUE CAN BE USED TO TREAT ESOPHAGEAL LESIONS SUCH AS BARRETTS MUCOSA AND IN ADDITION TO SMALL LESIONS OF THE STOMACH.

The excision is performed by injecting fluid into the mucosa under the tumor and separating the polyp/lesion from the mucosa below it. The mucosa is cut in pieces by a knife in the form of a loop until the tumor is completely removed.
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risks

The main risks of both methods (EMR, ESD) Bleeding or injury to the bowel/stomach/esophagus wall. The magnitude of the risk depends on the location of the lesion in the gastrointestinal tract, its size and method of treatment. In the vast majority of complications, it is possible to treat endoscopically without the need for surgery or additional treatment while maintaining the effectiveness of treatment.

In addition to the risks during the operation there is a risk of bleeding and the formation of a scar with stenosis (mainly esophageal). The complications are usually not severe and can be treated endoscopically.
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Continued medical follow-up

An integral part of the treatment is continued follow-up which includes endoscopy for review. Re-growth of the lesion can reach up to about 20% in some cases. However, these growths are small and treated effectively at the time of the audit with excellent long-term results.

Treatment of tumors of the gastrointestinal mucosa

Common tumors are of the following types:

1. NEUROENDOCRINE TUMOR (NET)

2. GASTROINTESTINAL STROMAL TUMOR (GIST)

3. OTHER (LEOMYOMA, LIPOMA, GRANULAR TUMOR CELL).

Each patient must undergo a preliminary diagnosis and evaluation before deciding on endoscopic resection, which include endoscopic ultrasound (E.U.) WITH OR IN LIBIOPSY AND IMAGING EXAMINATION SUCH AS CT (COMPUTER TOMOGRAPHY).

Tumors that do not penetrate into the muscular layer can be cut by EMR or ESD.

Tumors that involve the mucous layer can be excised using endoscopic methods such as:
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Submucosal tunneling endoscopic resection (STER)

STER is an oral approach surgery to remove a tumor of the upper gastrointestinal submucosa (esophagus/stomach). The method is suitable for excision of tumors with a diameter of 2-4 cm.

After a preliminary cut, the endoscope is inserted into the canal between the mucosa and the muscles of the wall of the esophagus or stomach. The canal is built up to the tumor itself, and then it is separated from the wall while preserving a mucosa that envelops the tumor. At the end of the operation, the initial incision is closed with clips.

The operation is performed without incisions in the abdominal wall and without tissue separation in order not to reveal the location of the tumor. One of the advantages of the STER method is that there is no damage to the mucosa and therefore there is no risk of discharge.
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(Endoscopic Full Thickness Resection - (EFTR

EFTR IS AN ORAL/RECTAL APPROACH SURGERY TO REMOVE A TUMOR OF THE UPPER/LOWER GASTROINTESTINAL SUBMUCOSA WITH COMPLETE EXCISION OF THE GASTRIUM/ESOPHAGUS/BOWEL WALL COMPRISING THE TUMOR. At the end of the operation, the defect in the wall can be closed by special clips or an endoscopic suture device.

As with the rest of endoscopic treatments, the main risks involve complications of bleeding or perforation up to about 15%, but even here most of them are amenable to endoscopic treatment. Also there is a fear of rupture of the capsule of the tumor and its dispersion in the abdominal cavity.
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Continued medical follow-up:

If the tumor is excised in its entirety, close endoscopic follow-up is not necessary after the operation.

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