Endoscopic resections for cancerous and precancerous lesions (polyps)

Advanced endoscopic (surgical) resection is a complex of procedures that focus on the treatment of common diseases of the digestive system, including polyp resection, vasectomy and even exit from the digestive system.
Following improvements in endoscopic equipment and the development of innovative techniques, endoscopic treatment, which enables a more accurate diagnosis of the disease, leads to excellent long-term results and constitutes a cheaper, higher quality and safer alternative compared to traditional surgery.

Advanced endoscopy, more complex than regular endoscopy, requires specific experience and study and is therefore performed in the hospital by a team skilled in this type of operation.
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• Treatment of precancerous/cancerous lesions of the gastrointestinal mucosa

• Treatment of tumors of the submucosa in the gastrointestinal tract
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Treatments for precancerous/cancerous lesions (including polyps) in the gastrointestinal tract.

Usually the initial diagnosis of a precancerous / cancerous lesion of the mucosa of the gastrointestinal tract will be made outside the hospital during an endoscopic examination. After preliminary processing of all data the doctor directs the further treatment to the hospital. We receive the referrals, go through the data, invite the patient to action after giving detailed explanations.

Careful endoscopic evaluation before resection of both the upper and lower gastrointestinal tracts is necessary for the correct determination of therapeutic strategy and the choice of the most appropriate endoscopic or surgical technique. We perform this assessment before the operation using the most advanced optical technologies, which allow us to estimate the degree of differentiation of the lesion and the risk of the presence of invasive cancer with an accuracy of up to 90%.

After evaluation, further treatment of the lesion will be carried out by one of the three possible options: ESD, EMR or surgery.

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ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD)

ESD - ENDOSCOPIC FASCINATION OF SUBMUCOUS MEMBRANES.

AN ADVANCED ENDOSCOPIC METHOD (WHICH WAS DEVELOPED IN JAPAN) FOR EXCISION OF LESIONS FROM THE MUCOSA OF THE GASTROINTESTINAL TRACT. THIS ALLOWS DEEP ENDOSCOPIC RESECTION OF LARGE POLYPS SUSPECTED OF BEING MALIGNANT AND TUMORS IN EARLY STAGES. ACCORDING TO A PRELIMINARY ENDOSCOPIC DIAGNOSIS WITHOUT THE NEED FOR SURGERY OR ADDITIONAL TREATMENT. ESD THAT ALLOWS COMPLETE RESECTION OF SUPERFICIAL TUMORS IN THE GASTROINTESTINAL TRACT, WITHOUT LIMITING THE SIZE OF THE LESION.

Such operations are performed by gastroenterologists experienced in invasive endoscopy, having undergone only appropriate training.

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ENDOSCOPIC MUCOSAL RESECTION (EMR)

EMR - ENDOSCOPIC RESECTION OF THE MUCOSA. 

The main use of this technique is in the large and small intestine for the removal of polyps larger than 20 mm. With the EMR method, polyps of any size can be removed, which do not have characteristics that suspect malignant involvement of the polyp.

IN ADDITION, IN SOME CASES THIS TECHNIQUE CAN BE USED TO TREAT ESOPHAGEAL LESIONS SUCH AS THE BARRETTS MUCOSA AND IN ADDITION TO SMALL LESIONS IN THE STOMACH.

The excision is performed by injecting fluid into the submucosa under the tumor and separating a polyp/lesion from the mucosa underneath it. The mucosa is cut in pieces by a loop-shaped knife until the tumor is completely removed.
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Risks

The main risks of both methods (EMR, ESD) are bleeding or damage to the intestinal wall/stomach/esophagus. The size of the risk depends on the location of the lesion in the digestive tract, its size and method of treatment. In the vast majority of complications, it is possible to treat endoscopically without the need for surgery or additional treatment while maintaining the effectiveness of the treatment.

In addition to the risks at the time of operation, there is a risk of bleeding and the formation of a scar with stenosis (mainly esophagus). The complications are usually not severe and can be treated endoscopically.
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Continue medical follow-up

An integral part of the treatment is the follow-up that includes endoscopy for control. Regrowth of the lesion can reach up to about 20% in some cases. However, these growths are small and are effectively handled during the audit with excellent long-term results.

Treatment of tumors of the submucous membrane in the gastrointestinal tract

Common tumors are of the type:

1. NEUROENDOCRINETUMOR (NET)

2. GASTROINTESTINAL STROMAL TUMOR (GIST)

3. OTHER (LIOMYOMA, LIPOMA, TUMOR CELL GRANULAR).

Each patient must undergo a preliminary diagnosis and evaluation before deciding on endoscopic resection, which includes endoscopic ultrasound (EUS) with or in a libbiopsy and an imaging test such as CT (computer tomography).

Tumors that do not penetrate the muscular layer can be removed by EMR or ESD.

Tumors involving the mucosal layer can be removed by endoscopic methods such as:
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Submucosal tunneling endoscopic resection (STER)

STER is an oral surgery to remove a tumor of a submucosa in the upper gastrointestinal tract (esophagus/stomach). The method is suitable for excision of tumors 2-4 cm in diameter.

After an initial cut, the endoscope is inserted into the canal between the mucosa and the wall muscles of the esophagus or stomach. The canal is built until the tumor itself and then it is separated from the wall while preserving the mucosa that surrounds the tumor. At the end of the operation, the initial incision closes with clips.

The surgery is performed without incisions in the abdominal wall and without tissue separation in order not to reveal the location of the tumor. One of the advantages of the STER method is that there is no damage to the mucosa and therefore there is no risk of narrowing.
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(Endoscopic Full Thickness Resection - (EFTR

EFTR is an oral/rectal surgery to remove a tumor of an upper/lower gastrointestinal submucosa with complete gastric/esophagus/intestinal wall resection that includes the tumor. At the end of the operation, the defect in the wall can be closed by special clips or an endoscopic suturing device.

As with other endoscopic treatments, the main risks involve complications of bleeding or proportionation up to about 15%, but here too most of them can be treated endoscopically. There is also a concern of breakout of the tumor capsule and its dispersal in the abdominal cavity.
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Follow-up medical follow-up:

If a tumor is excised in its entirety, there is no need for close endoscopic follow-up after the operation.

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