Current status and new development of endoscopic resection for GI neoplasms in China

Pinghong Zhou, MD
Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

The development of endoscopic resection (ER) methods has experienced the periods of polypectomy, endoscopic mucosal resection (EMR), and piecemeal EMR (EPMR), now entering the new era of endoscopic submucosal dissection (ESD).

The ESD technique was applied in GI mucosal lesions (early GI cancers, precancerous lesions), submucosal tumors (SMTs) within submucosal layer.

More new methods were introduced into clinical practice from June 2006. As for SMT originated from muscularis propria, endoscopic submucosal excavation (ESE) was applied to resect the whole lesion. Endoscopic full-thickness resection (EFR) was carried out for SMT within muscularis propria and adhensive to serosa, prostruding outside the GI lumen. EFR technique consists of several major procedures: (1) a circumferential incision as deep as muscularis propria around the lesion, (2) incision into serosal layer around the lesion, (3) completion of full-thickness incision to the tumor including the serosal layer without laparoscopic assistance, (4) complete closure of the GI wall defect with metallic clips.

Peroral endoscopic myotomy (POEM) has been performed for esophageal achalasia (AC) since August 2010. The key procedures of POEM were as following, (1) esophageal mucosal incision, (2) submucosal “tunnelling” by endoscopic ESD technique, (3) endoscopic myotomy of the circular muscle, (4) closure of mucosal entry by hemostatic clips. Till now POEM has been performed for more than 800 cases of achalasia in China.

All of those methods have achieved satisfactory clinical results so far. Further clinical observations are now carrying out. With the development of ESD and EFR, the indication of ER may be expanded. Endoscopic surgical procedure techniques have still to be improved.