| Invited Lecture(JGES) |
| Thu. October 31st 14:00 - 14:30 Room 9: Portopia Hotel Main Building Kairaku 3 |
| Current situation of endoscopic resection of GI neoplasia in Europe and future direction | |||
| Helmut Messmann | |||
| Department of Gastroenterology, University Hospital Augsburg | |||
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| The current situation of endoscopic resection of GI-neoplasia in the GI-tract is mainly influenced by the location (esophagus, stomach, duodenum and colorectum). In addition, the dignity of the lesion and size influences the resection technique. Squamous cell cancer in the esophagus is rare in Europe, but the ESGE guideline recommends ESD for all lesions larger than 15mm. In contrast Barrett neoplasia is becoming one of the most frequent lesions in the upper GI-tract. There is still a debate whether ESD or EMR is the method of choice. Lesions larger 15mm or with suspicion of deep submucosal infiltration as well as bulky or scarred lesions and recurrences should be treated with ESD. However, the differentiation of mucosal and submucosal lesions is challenging and the accuracy is even for experts lower than 70%. After endoscopic resection the remaining Barrett mucosa needs to be ablated. In Barrett´s esophagus without visible lesions but dysplasia in the flat mucosa ablation is also recommended. The number of gastric cancer is decreasing and no screening programs exists for the upper GI tract. Therefore, gastric cancer fulfill mainly the expanded criteria. ESGE guideline recommends ESD for all lesions larger than 15mm. Endoscopic resection is the treatment of choice for all guideline and expanded criteria. The majority of duodenal lesions are benign adenoma. The complication rate for endoscopic resection regarding bleeding and perforation rate is high. Therefor piecemeal EMR is the gold standard as a safe technique. Maybe in the future cold snare resection will become the gold standard since the delayed bleeding rate is much lower. In the colon/rectum many resection techniques are available: Hot and cold EMR with additive snare tip coagulation, underwater EMR, ESD, EID and full thickness resection. Depending on size, location, dignity, pretreatment, but also center/endoscopists experience and clinical situation of the patient (age, comorbidities) the adequate resection technique will be selected. More and more Artificial intelligence plays an important role to detect and characterize the lesion in order to use the best technique. In special situations organ preserving surgery is combined with endoscopic resection. Case volume and center experience is more and more the driving force in the treatment of early GI-neoplasia in Europe. |
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