Skip to main content
SpringerLink
Log in
SpringerLink
Log in

Endoscopic Mucosal Resection: Upper Gastrointestinal Tract

  • Chapter
  • First Online:
The SAGES Manual Operating Through the Endoscope

  • 874 Accesses

Abstract

Despite advances in minimally invasive surgery, esophagectomy and gastric resection remain morbid procedures for cancers of the upper gastrointestinal tract. Endoscopy offers patients effective screening and treatment of early-stage cancers. Endoscopic mucosal resection can effectively remove benign and early malignant lesions. This chapter focuses on the use of endoscopic mucosal resection in the upper digestive tract.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

BE:

Barrett’s esophagus

EGC:

Early gastric cancers

EMR:

Endoscopic mucosal resection

EUS:

Endoscopic ultrasound

FAP:

Familial adenomatous polyposis

GERD:

Gastroesophageal reflux disease

HGD:

High-grade dysplasia

IMC:

Intramucosal carcinoma

LGD:

Low-grade dysplasia

SDA:

Sporadic duodenal adenomas

References

  1. Brown LM, Devesa SS, Chow WH. Incidence of adenocarcinoma of the esophagus among white Americans by sex, stage, and age. J Natl Cancer Inst. 2008;100(16):1184–7.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Pohl H, Sirovich B, Welch HG. Esophageal adenocarcinoma incidence: are we reaching the peak? Cancer Epidemiol Biomarkers Prev. 2010;19:1468–70.

    Article  PubMed  Google Scholar 

  3. Engel LS, Chow WH, Vaughan TL, Gammon MD, Risch HA, Stanford JL, et al. Population attributable risks of esophageal and gastric cancers. J Natl Cancer Inst. 2003;95:1404–13.

    Article  PubMed  Google Scholar 

  4. Aichler M, Walch A. In brief: the (molecular) pathogenesis of Barrett’s oesophagus. J Pathol. 2014;232(4):383–5.

    Article  PubMed  Google Scholar 

  5. Shaheen NJ, Crosby MA, Bozymski EM, Sandler RS. Is there a publication bias in reporting cancer risk in Barrett’s esophagus? Gastroenterology. 2000;119:333–8.

    Article  CAS  PubMed  Google Scholar 

  6. van Soest EM, Dieleman JP, Siersema PD, Sturkenboom MC, Kuipers EJ. Increasing incidence of Barrett’s esophagus in the general population. Gut. 2005;54:1062–6.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Sharma P, Falk GW, Weston AP, Reker D, Johnston M, Sampliner RE. Dysplasia and cancer in a large multicenter cohort of patients with Barrett’s esophagus. Clin Gastroenterol Hepatol. 2006;4:566–72.

    Article  PubMed  Google Scholar 

  8. Roder DM. The epidemiology of gastric cancer. Gastric Cancer. 2002;5(1):5–11.

    Article  PubMed  Google Scholar 

  9. Ekstrom AM, Serafini M, Nyren O, Hansson LE, Ye W, Wolk A. Dietary antioxidant intake and risk of cardia cancer and noncardia cancer of the intestinal types: a population-based casecontrol study in Sweden. Int J Cancer. 2000;87:133–40.

    Article  CAS  PubMed  Google Scholar 

  10. Nomura A. Stomach cancer. In: Schottenfeld D, Fraumeni JF, editors. Cancer epidemiology and prevention. 2nd ed. New York: Oxford University Press; 1996. p. 707–24.

    Google Scholar 

  11. Maruyama K, Kaminishi M, Hayashi K, Isobe Y, Honda I, Katai H, et al. Gastric cancer treated in 1991 in Japan: data analysis of nationwide registry. Gastric Cancer. 2006;9:51–66.

    Article  PubMed  Google Scholar 

  12. Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995;345:745–8.

    Article  CAS  PubMed  Google Scholar 

  13. Gotoda T. Endoscopic resection of early gastric cancer: the Japanese perspective. Curr Opin Gastroenterol. 2006;22(5):561–9.

    Article  PubMed  Google Scholar 

  14. Strong VE, Song KY, Park CH, Jacks LM, Gonen M, Shah M, et al. Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram. Ann Surg. 2010;251:640–6.

    Article  PubMed  Google Scholar 

  15. Sellner F. Investigations on the significance of the adenomacarcinoma sequence in the small bowel. Cancer. 1990;66:702–15.

    Article  CAS  PubMed  Google Scholar 

  16. Witteman BJ, Janssens AR, Griffioen G, Lamers CB. Villous tumours of the duodenum: an analysis of the literature with emphasis on malignant transformation. Neth J Med. 1993;42:5–11.

    CAS  PubMed  Google Scholar 

  17. Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg. 2006;244:10–5.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Lepilliez V, Chemaly M, Ponchon T, Napoleon B, Saurin JC. Endoscopic resection of sporadic duodenal adenomas: an efficient technique with a substantial risk of delayed bleeding. Endoscopy. 2008;40:806–10.

    Article  CAS  PubMed  Google Scholar 

  19. Endo M, Abiko Y, Oana S, Kudara N, Chiba T, Suzuki K, et al. Sefulness of endoscopic treatment for duodenal adenoma. Dig Endosc. 2010;22:360–5.

    Article  PubMed  Google Scholar 

  20. Kim GH, Kim JI, Jeon SW, Moon JS, Chung IK, Jee SR, et al. Endoscopic resection for duodenal carcinoid tumors: a multicenter, retrospective study. J Gastroenterol Hepatol. 2014;29(2):318–24.

    Article  PubMed  Google Scholar 

  21. Agostoni M, Fanti L, Gemma M, Pasculli N, Beretta L, Testoni PA. Adverse events during monitored anesthesia care for GI endoscopy: an 8-year experience. Gastrointest Endosc. 2011;74(2):266–75.

    Article  PubMed  Google Scholar 

  22. Ajani JA, D’Amico TA, Almhanna K, Beer DG, Bentrem DJ, Besh S, et al. Esophageal cancer. JNCCN. 2014;v1.

    Google Scholar 

  23. Ajani JA, D’Amico TA, Almhanna K, Beer DG, Bentrem DJ, Besh S, et al. Gastric cancer. JNCCN. 2014;1.

    Google Scholar 

  24. Larghi A, Lightdale CJ, Memeo L, Bhagat G, Okpara N, Rotterdam H. EUS followed by EMR for staging of high-grade dysplasia and early cancer in Barrett’s esophagus. Gastrointest Endosc. 2005;62(1):16–23.

    Article  PubMed  Google Scholar 

  25. Mino-Kenudson M, Brugge WR, Puricelli WP, Nakatsuka LN, Nishioka NS, Zukerberg LR, et al. Management of superfi cial Barrett’s epithelium-related neoplasms by endoscopic mucosal resection: clinicopathologic analysis of 27 cases. Am J Surg Pathol. 2005;29:680–6.

    Article  PubMed  Google Scholar 

  26. Dunbar KB, Spechler SJ. The risk of lymph-node metastases in patients with high-grade dysplasia or intramucosal carcinoma in Barrett's esophagus: a systematic review. Am J Gastroenterol. 2012;107(6):850–62.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–25.

    Article  PubMed  Google Scholar 

  28. Moss A, Bourke MJ, Hourigan LF, Gupta S, Williams SJ, Tran K. Endoscopic resection for Barrett’s high-grade dysplasia and early esophageal adenocarcinoma: an essential staging procedure with long-term therapeutic benefit. Am J Gastroenterol. 2010;105(6):1276–83.

    Article  PubMed  Google Scholar 

  29. Spechler SJ. Barrett esophagus and risk of esophageal cancer: a clinical review. JAMA. 2013;310(6):627–36.

    Article  CAS  PubMed  Google Scholar 

  30. ASGE Technology Committee, Kantsevoy SV, Adler DG, Conway JD, Diehl DL, Farraye FA, et al. Endoscopic mucosal resection and endoscopic submucosal dissection. Gastrointest Endosc. 2008;68(1):11–8.

    Article  Google Scholar 

  31. Chandrasekhara V, Ginsberg G. Endoscopic mucosal resection: not your father’s polypectomy anymore. Gastroenterology. 2011;141:42–9.

    Article  PubMed  Google Scholar 

  32. Soetikno R, Kaltenbach T, Yeh R, Gotoda T. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol. 2005;23(20):4490–8.

    Article  PubMed  Google Scholar 

  33. Sato T. A novel method of endoscopic mucosal resection assisted by submucosal injection of autologous blood (blood patch EMR). Dis Colon Rectum. 2006;49(10):1636–41.

    Article  PubMed  Google Scholar 

  34. May A, Gossner L, Pech O, Fritz A, Günter E, Mayer G, et al. Local endoscopic therapy for intraepithelial high-grade neoplasia and early adenocarcinoma in Barrett’s oesophagus: acute-phase and intermediate results of a new treatment approach. Eur J Gastroenterol Hepatol. 2002;14:1085–91.

    Article  PubMed  Google Scholar 

  35. May A, Gossner L, Pech O, Müller H, Vieth M, Stolte M, et al. Intraepithelial high-grade neoplasia and early adenocarcinoma in short-segment Barrett’s esophagus (SSBE): curative treatment using local endoscopic treatment techniques. Endoscopy. 2002;34:604–10.

    Article  CAS  PubMed  Google Scholar 

  36. Qumseya BJ, Wolfsen C, Wang Y, Othman M, Raimondo M, Bouras E, et al. Factors associated with increased bleeding post-endoscopic mucosal resection. J Dig Dis. 2013;14(3):140–6.

    Article  CAS  PubMed  Google Scholar 

  37. Basford PJ, George R, Nixon E, Chaudhuri T, Mead R, Bhandari P. Endoscopic resection of sporadic duodenal adenomas: comparison of endoscopic mucosal resection (EMR) with hybrid endoscopic submucosal dissection (ESD) techniques and the risks of late delayed bleeding. Surg Endosc. 2014;28(5):1594–600.

    Article  PubMed  Google Scholar 

  38. Namasivayam V, Prasad GA, Lutzke LS, Dunagan KT, Borkenhagen LS, Okoro NI, et al. The risk of endoscopic mucosal resection in the setting of clopidogrel use. ISRN Gastroenterol. 2014;2014:494157.

    PubMed Central  PubMed  Google Scholar 

  39. ASGE Standards of Practice Committee, Anderson MA, Ben-Menachem T, Gan SI, Appalaneni V, Banerjee S, et al. Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc. 2009;70:1060–70.

    Article  Google Scholar 

  40. Qumseya B, Panossian AM, Rizk C, Cangemi D, Wolfsen C, Raimondo M, et al. Predictors of esophageal stricture formation post endoscopic mucosal resection. Clin Endosc. 2014;47(2):155–61.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Machida H, Tominaga K, Minamino H, Sugimori S, Okazaki H, Yamagami H, et al. Locoregional mitomycin C injection for esophageal stricture after endoscopic submucosal dissection. Endoscopy. 2012;44(6):622–5.

    Article  CAS  PubMed  Google Scholar 

  42. Wu Y, Schomisch SJ, Cipriano C, Chak A, Lash RH, Ponsky JL, et al. Preliminary results of antiscarring therapy in the prevention of postendoscopic esophageal mucosectomy strictures. Surgical Endosc. 2014;28(2):447–55.

    Article  Google Scholar 

  43. Pauli EM, Schomisch SJ, Furlan JP, Marks AS, Chak A, Lash RH, et al. Biodegradable esophageal stent placement does not prevent high-grade stricture formation after circumferential mucosal resection in a porcine model. Surgical Endosc. 2012;26(12):3500–8.

    Article  Google Scholar 

  44. Ohki T, Yamato M, Ota M, Takagi R, Murakami D, Kondo M, et al. Prevention of esophageal stricture after endoscopic submucosal dissection using tissue-engineered cell sheets. Gastroenterology. 2012;143(3):582–8.e1-2.

    Article  PubMed  Google Scholar 

  45. Jovani M, Wallace M. Is complete endoscopic resection still a viable option for barrett’s-related dysplasia and neoplasia? Clin Gastroenterol Hepatol. 2014. pii: S1542-3565(14)00979-3.

    Google Scholar 

  46. Takahashi H, Arimura Y, Okahara S, Uchida S, Ishigaki S, Tsukagoshi H, et al. Risk of perforation during dilation for esophageal strictures after endoscopic resection in patients with early squamous cell carcinoma. Endoscopy. 2011;43(3):184–9.

    Article  CAS  PubMed  Google Scholar 

  47. Riley SA, Attwood SEA. Guidelines on the use of oesophageal dilatation in clinical practice. Gut. 2004;53:i1–6.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Tomizawa Y, Iyer PG, Wong Kee Song LM, Buttar NS, Lutzke LS, Wang KK. Safety of endoscopic mucosal resection for Barrett’s esophagus. Am J Gastroenterol. 2013;108(9):1440–7.

    Article  PubMed  Google Scholar 

  49. Ishihara R, Iishi H, Uedo N, Takeuchi Y, Yamamoto S, Yamada T, et al. Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan. Gastrointest Endosc. 2008;68(6):1066–72.

    Article  PubMed  Google Scholar 

  50. Isomoto H, Yamaguchi N, Minami H, Nakao K. Management of complications associated with endoscopic submucosal dissection/endoscopic mucosal resection for esophageal cancer. Dig Endosc. 2013;25 Suppl 1:29–38.

    Article  PubMed  Google Scholar 

  51. Min YW, Min BH, Kim ER, Lee JH, Rhee PL, Rhee JC, et al. Efficacy and safety of endoscopic treatment for nonampullary sporadic duodenal adenomas. Dig Dis Sci. 2013;58(10):2926–32.

    Article  PubMed  Google Scholar 

  52. Chennat J, Konda VJA, Ross AS, Herreros de Tejada A, Noffsinger A, et al. Complete Barrett’s eradication endoscopic mucosal resection: an effective treatment modality for high-grade dysplasia and intramucosal carcinoma – an American single-center experience. Am J Gastroeterol. 2009;104:2684–92.

    Article  Google Scholar 

  53. Ell C, May A, Gossner L, Pech O, Günter E, Mayer G, et al. Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett’s esophagus. Gastroenterology. 2000;118:670–7.

    Article  CAS  PubMed  Google Scholar 

  54. Nijhawan PK, Wang KK. Endoscopic mucosal resection for lesions with endoscopic features suggestive of malignancy and high-grade dysplasia within Barrett’s esophagus. Gastrointest Endosc. 2000;52:328–32.

    Article  CAS  PubMed  Google Scholar 

  55. Waxman I, Saitoh Y. Clinical outcome of endoscopic mucosal resection for superficial GI lesions and the role of high-frequency US probe sonography in an American population. Gastroenterol Endosc. 2000;52:322–7.

    Article  CAS  Google Scholar 

  56. Buttar NS, Wang KK, Lutzke LS, Krishnadath KK, Anderson MA. Combined endoscopic mucosal resection and photodynamic therapy for esophageal neoplasia within Barrett’s esophagus. Gastrointest Endosc. 2001;54:682–8.

    CAS  PubMed  Google Scholar 

  57. Pacifico RJ, Wang KK, Wongkeesong L, Buttar NS, Lutzke LS. Combined endoscopic mucosal resection and photodynamic therapy versus esophagectomy for management of early adenocarcinoma in Barrett’s esophagus. Clin Gastroenterol Hepatol. 2003;1:252–7.

    Article  PubMed  Google Scholar 

  58. Peters FP, Kara MA, Rosmolen WD, Aalders MC, Ten Kate FJ, Bultje BC, et al. Endoscopic treatment of high-grade dysplasia and early stage cancer in Barrett’s esophagus. Gastrointest Endosc. 2005;61:506–14.

    Article  PubMed  Google Scholar 

  59. Seewald S, Akaraviputh T, Seitz U, Brand B, Groth S, Mendoza G, et al. Circumferential EMR and complete removal of Barrett’s epithelium: a new approach to management of Barrett’s esophagus containing high-grade intraepithelial neoplasia and intramucosal carcinoma. Gastrointest Endosc. 2003;57:854–9.

    Article  PubMed  Google Scholar 

  60. Ell C, May A, Pech O, Gossner L, Guenter E, Behrens A, et al. Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc. 2007;65(1):3–10.

    Article  PubMed  Google Scholar 

  61. Pech O, Behrens A, May A, et al. Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut. 2008;57:1200–6.

    Article  CAS  PubMed  Google Scholar 

  62. Perry KA, Walker JP, Salazar M, Suzo A, Hazey JW, Melvin WS. Endoscopic management of high-grade dysplasia and intramucosal carcinoma: experience in a large academic medical center. Surg Endosc. 2014;28(3):777–82.

    Article  PubMed  Google Scholar 

  63. Park YM, Cho E, Kang HY, Kim JM. The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and metaanalysis. Surg Endosc. 2011;25(8):2666–77.

    Article  PubMed  Google Scholar 

  64. Hirasawa R, Iishi H, Tatsuta M, Ishiguro S. Clinicopathologic features and endoscopic resection of duodenal adenocarcinomas and adenomas with the submucosal saline injection technique. Gastrointest Endosc. 1997;46(6):507–13.

    Article  CAS  PubMed  Google Scholar 

  65. Apel D, Jakobs R, Spiethoff A, Riemann JF. Follow-up after endoscopic snare resection of duodenal adenomas. Endoscopy. 2005;37(5):444–8.

    Article  CAS  PubMed  Google Scholar 

  66. Alexander S, Bourke MJ, Williams SJ, Bailey A, Co J. EMR of large, sessile, sporadic nonampullary duodenal adenomas: technical aspects and long-term outcome (with videos). Gastrointest Endosc. 2009;69(1):66–73.

    Article  PubMed  Google Scholar 

  67. Kedia P, Brensinger C, Ginsberg G. Endoscopic predictors of successful endoluminal eradication in sporadic duodenal adenomas and its acute complications. Gastrointest Endosc. 2010;72(6):1297–301.

    Article  PubMed  Google Scholar 

  68. Giovannini M, Bories E, Pesenti C, Moutardier V, Monges G, Danisi C, Lelong B, Delpero JR. Circumferential endoscopic mucosal resection in Barrett’s esophagus with high-grade intraepithelial neoplasia or mucosal cancer. Preliminary results in 21 patients. Endoscopy. 2004;36(9):782–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of General and Gastrointestinal Surgery, Department of Surgery, Wexner Medical Center, The Ohio State University, 410 W 10th Avenue, N717 Doan Hall, Columbus, OH, 43210, USA

    Sara A. Mansfield M.D. & Sabrena F. Noria M.D., Ph.D.

Authors
  1. Sara A. Mansfield M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sabrena F. Noria M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sabrena F. Noria M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Cleveland Clinic, Section of Surgical Endoscopy, Cleveland, Ohio, USA

    Matthew Kroh

  2. The Oregon Clinic, Division of Gastrointestinal Surgery, Portland, Oregon, USA

    Kevin M. Reavis

Rights and permissions

Reprints and permissions

Copyright information

© 2016 SAGES

About this chapter

Cite this chapter

Mansfield, S.A., Noria, S.F. (2016). Endoscopic Mucosal Resection: Upper Gastrointestinal Tract. In: Kroh, M., Reavis, K. (eds) The SAGES Manual Operating Through the Endoscope. Springer, Cham. https://doi.org/10.1007/978-3-319-24145-6_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-24145-6_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-24143-2

  • Online ISBN: 978-3-319-24145-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation