The 4th Joint Session between JDDW-KDDW-TDDW2(JDDW)
Thu. November 5th   14:00 - 16:15   Room 9: Portopia Hotel Main Building Kairaku 3
JKT2-RS2
 New endoscopic technology for gastroesophageal junction tumor treatment
Hyuk Soon Choi
Korea University College of Medicine
Choosing treatment for gastroesophageal junction tumor (GEJ) has been one of the most difficult decisions for gastroenterologist since the quality of patients varies depending on the treatment. In case of GEJ cancer, it can be treated with either total gastrectomy, esophagectomy or proximal gastrectomy depending on the severity of disease, and if GEJ cancer is diagnosed at early stage, endoscopic treatment may be the curative treatment option. If there is certainty of complete removal of tumor, endoscopic treatment would be the best option for patients in the aspect of patient’s quality of life.
The very first step is to make accurate diagnosis and depth of cancer invasion should be measured with endoscopic ultrasound (EUS), one of the most accurate diagnostic tools. However, it may be difficult to obtain accurate information depending on the types of malignancies and how experienced operators are, since EUS is an operator-dependent method. There have been several attempts to make up for the weakness. Confocal endoscopy and Optical Coherence Tomography (OCT) have been used, and our research team is currently working on photoacoustic endoscopy, which shows the possibility of developing new modality which can determine depth of invasion more accurately.
Currently, endoscopic treatment of choice for GEJ tumor is the endoscopic submucosal dissection (ESD). Recently, submucosal tunneling endoscopic resection of SET or wide circular esophageal cancer is considered as one of the treatment options. However, because tumors are located in curved area which makes it difficult for operators, new methods have been proposed to overcome these obstacles. Recently, our research team has tried to overcome the previous difficulties by using robot assisted endoscopy. Robot endoscopy is still a new field, but it has shown tremendous potentials. Also, electrical ablation therapy can be another option. Previously, tumors in EGJ were removed by endoscopic mucosal resection (EMR) and electrical ablation therapy was applied, which showed satisfying results. Our research team also showed good results such as irreversible electroporation in animal experiments using by new electrical ablation therapy.
New endoscopic diagnosis and treatment for EGJ tumors is still challenging but showing great progress. If minimally invasive therapy for GEJ tumors with endoscopic modalities is established, we can expect to complete cure of the EGJ tumor as well as improving patient’s quality of life.
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