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Ulster Med J. 2017 January; 86(1): 73.
PMCID: PMC5324192

THE CHANGING ROLE OF THERAPEUTIC ENDOSCOPY IN GASTROENTEROLOGY: IMPROVING PATIENT OUTCOMES

Endoscopy plays a critical role in the staging, sampling and curative resections of gastroenterology cancers, as well as the opportunity for non-surgical palliative techniques.

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been developed for the en-bloc removal of pre-cancerous and early malignant lesions in the GI tract, such as dysplastic Barrett’s and early GI cancers.

EMR uses a suction cap or band ligation to snare the lesion, while ESD uses a specialised knife to dissect the submucosa below the lesion.1 They provide the same curative outcomes with fewer complications than major surgery in early cancers and give a valuable alternative for patients who would not be fit for surgical intervention.

Radio-frequency ablation (RFA) is a technique where a circumferential ablation catheter or direct catheters use heat energy to remove dysplastic cells in Barrett’s.2 It has been shown to produce a high rate of eradication of dysplasia and decrease disease progression.

The introduction of Self Expanding Metal Stents (SEMS) for palliative oesophageal and obstructive colorectal cancer have greatly improved outcomes and decreased complication rates such as stent migration. This in turn improves patient quality of life, reduces the need for risky palliative surgical procedures and decreases re-intervention rates.

The role of endoscopy within the field of gastroenterology is always evolving giving more options for our patients with the aim of continued improvement in outcomes, now and in the future.

References

1. Shim Ki-Nam, Chang Ji Young. Clinical outcome of endoscopic submucosal dissection versus surgery for patients with early gastric cancer. J Clin Oncol. 2016;34(suppl 4S) abstr 15.
2. Shaheen Nicholas J, Sharma Prateek, et al. Radiofrequency Ablation in Barrett’s Esophagus with Dysplasia. N Engl J Med May 28. 2009;360(22):2277. [PubMed]

Articles from The Ulster Medical Journal are provided here courtesy of Ulster Medical Society