Endoscopic Resection

What is Endoscopic Resection?

Endoscopic resection is a minimally invasive procedure that uses an endoscope to remove abnormal tissues in the gastrointestinal tract. The endoscope is a flexible tube equipped with a camera and surgical tools, which allows the gastroenterologist to visualise and remove any abnormal tissues present in the digestive tract. This procedure commonly removes precancerous growths, tumours, and other abnormal tissues in the entire digestive tract.

Who is Suitable for Endoscopic Resection?

• Early-Stage Cancer Patients: Those with early-stage cancers are confined to the superficial layers of the digestive tract lining (mucosa and submucosa), where there's a low risk of cancer spreading to lymph nodes or other parts. 
• Large Polyps: Patients with large or sessile (flat) polyps that are difficult to remove with traditional polypectomy during a standard colonoscopy. 
• Precancerous Conditions: Individuals with conditions like Barrett's oesophagus with dysplasia which can progress to esophageal cancer, making them good candidates for EMR. 
• Localised Lesions: Patients with lesions localised to the mucosal layer that haven’t invaded deeper tissues or spread to other body parts.

Benefits of Endoscopic Resection

• Minimally invasive: Endoscopic resection is a minimally invasive procedure that does not require incisions. This means patients experience less pain and a shorter recovery time than with traditional surgical procedures.
• High success rate: Endoscopic resection has a high success rate in removing abnormal gastrointestinal tissue. This means that patients are less likely to experience a recurrence of their condition.
• Low risk of complications: Endoscopic resection has a low risk of complications compared to traditional surgical procedures. Patients are less likely to experience postoperative complications, such as infections, bleeding, or perforation.
• Early detection: Endoscopic resection is often used as a diagnostic tool to detect precancerous growths or early-stage cancer in the gastrointestinal tract. This allows patients to receive treatment early, increasing their survival chances.
• Cost: Endoscopic resection is often more cost effective than it's comparative

Types of Endoscopic Procedures

The two common methods include 

• Endoscopic Mucosal Resection (EMR) and 
• Endoscopic Submucosal Dissection (ESD).

EMR involves using a snare wire loop to remove the abnormal tissue. The gastroenterologist inserts the endoscope into the gastrointestinal tract and injects a solution of succinylated gelatin infused with a blue-coloured dye and adrenaline into the submucosal layer of the bowel wall. This separates the target lesion away from normal bowel tissue. A snare is then positioned around the abnormal tissue. The snare is then tightened, cutting the abnormal tissue away from the surrounding tissue.

ESD involves the use of a specialised electrosugical knife to remove abnormal tissue. The gastroenterologist inserts the endoscope with the specialised knife into the gastrointestinal tract and carefully dissects the abnormal tissue away from the surrounding normal tissue. ESD is similar to EMR but involves more extensive tissue dissection beneath the mucosa. ESD may be recommended for larger or more complex lesions that cannot be removed using EMR.

The removed tissue will be sent to a laboratory for analysis.

Preparation Before EMR or ESD

Before endoscopic resection, you must prepare for the procedure by following your gastroenterologist's instructions. 

• You may need to fast for several hours before the procedure, and your gastroenterologist may recommend that you stop taking certain medications before the procedure. 
• You must also arrange for someone to drive you home after the procedure, as you will be sedated.

After the Procedure

After EMR, you must stay in the recovery room until the sedative wears off. You may experience discomfort or bloating, but this should subside within a few hours. Your gastroenterologist will provide instructions on what to eat and drink after the procedure and when you can resume your normal activities.

Endoscopic Resection Recovery

In the First 24 Hours

It is normal to experience discomfort or bloating in the first few hours after the procedure. Over-the-counter pain medications, such as paracetamol can manage this discomfort. However, you should avoid driving, operating heavy machinery, or making important decisions for at least 24 hours after the procedure, as the sedative may affect your judgement and reflexes.

Diet and Activity

Your gastroenterologist will provide specific instructions on when to resume eating and drinking after the procedure. In most cases, patients can resume a regular diet immediately after the procedure. However, you should avoid consuming alcohol, caffeine, or other substances that may irritate your gastrointestinal tract for the first 24 hours.

Your gastroenterologist will also provide specific instructions on when you can resume your normal activities. Most patients can resume regular activities within a day or two after the procedure. However, you should avoid strenuous exercise, heavy lifting, or other activities that may strain your abdominal muscles for at least a week after the procedure.

Follow-Up Appointments

Your gastroenterologist will schedule a follow-up appointment to discuss the EMR/ESD procedure's results and any further treatment that may be necessary. Depending on the nature of the abnormal tissue removed, your gastroenterologist may recommend additional testing or imaging to monitor the affected area.

Endoscopic Resection Prognosis

Prognosis depends on several factors, including the size and location of the lesion, the stage of cancer (if present), and the patient's overall health. However, in general, EMR/ESD has a high success rate in removing abnormal tissues, and the prognosis is often excellent for patients with early-stage cancer or precancerous growths.

Endoscopic Resection Risks

Like any medical procedure, EMR/ESD carries some risks. The risks include bleeding, infection, perforation of the gastrointestinal tract, and serositis/ post-EMR syndrome. Post-EMR syndrome can cause fever, abdominal pain, and other symptoms and may require hospitalisation but usually resolves with conservative therapy.

What if Endoscopic Resection is Delayed?

EMR/ESD is often recommended for patients with precancerous growths or early-stage cancer, and a delay in the procedure may lead to a delay in treatment, which can affect the prognosis.

It is essential to communicate with your gastroenterologist about any concerns or questions regarding the delay of your EMR/ESD procedure. They can help you understand the risks and benefits of the available options and work with you to develop a treatment plan tailored to your needs and circumstances.

Alternative Options to Endoscopic Resection

While EMR/ESD is a valuable diagnostic and treatment tool, it is not always the best option for some patients. Alternative options to EMR include:

• Surgical resection: Surgical resection involves surgically removing the lesion or the affected part of the gastrointestinal tract. Surgical resection is often recommended for patients with advanced-stage cancer unsuitable for EMR or ESD.
• Radiofrequency ablation (RFA): RFA involves using a catheter with an electrode to deliver an electrical current to the abnormal tissue. This current heats and destroys the tissue. RFA is often recommended for Barrett's oesophagus patients.