Current and Future Developments in Surgery

Volume: 2

Endoscopic Therapeutic Procedures

Author(s): Hugh Dalziel and Sami M. Shimi

Pp: 211-259 (49)

DOI: 10.2174/9781681086590118020010

* (Excluding Mailing and Handling)


The application of endoscopic resection (ER) and endoscopic submucosal dissection (ESD) to gastrointestinal (GI) early neoplasms is limited to lesions with limited depth of invasion with no risk of nodal metastasis. Endoscopic electrosurgical knives are used in combination with high frequency electrosurgical current. Radiofrequency ablation (RFA) is the modality of choice for dysplastic lesions due to its efficacy and low side effect profile. ER and RFA could be used together in combination with encouraging results. Acute upper gastrointestinal bleeding (UGBI) is a common medical emergency and has an average 10% in-hospital mortality rate. A risk stratification score should be calculated and used to guide subsequent management. Endoscopic therapy can be categorized into injection therapy, thermal coagulation, and mechanical haemostasis. The optimal choice of the endoscopic technique depends on the bleeding source, the endoscopists’ skills, the available equipment, the patient's clinical condition and costs. Endoscopic stenting has become the palliative treatment of choice for many patients with malignant oesophageal obstruction. However, the procedure is associated with a high incidence of complications. Stenting is widely used as a first line treatment option in patients that are not suitable for surgery and those with limited survival. Stents consist of a flexible framework of wire mesh, and are either uncovered or covered. Some have anti-reflux valves as an option.

Keywords: Dysplasia, Endoscopic treatment, Gastric cancer, Injection therapy, Oesophageal cancer, Oesophageal stenting, Pyloric stenting, Radio-frequency ablation, Rebleeding risk, Thermal coagulation, Topical therapy.

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