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What is endoscopic mucosal resection?
Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is a minimally invasive surgical technique performed endoscopically to remove mucosal lesions in the body that have not yet invaded the submucosa, such as in the gastrointestinal tract (stomach, intestines) or in other organs with mucosa. This technique is often used to remove tumors, polyps, or precancerous lesions without major surgery.
ESD (Endoscopic Submucosal Dissection) was developed from the traditional technique called EMR (Endoscopic Mucosal Resection). EMR is a method that uses a metal loop (snare) to remove a lesion by cutting through the mucosal layer, typically for small lesions under 2cm, such as early-stage cancer or polyps. In contrast, the technique of submucosal dissection (ESD) allows for deeper dissection beneath the mucosal layer (called the submucosal layer), removing the entire lesion as one piece.
ESD enables doctors to remove early-stage cancerous lesions both horizontally and deeply, reaching close to the muscle layer of the gastrointestinal tract wall to ensure the complete removal of the lesion. The primary goal of ESD is to remove the lesion in one single piece (en bloc). Essentially, ESD is used for removing early-stage cancer lesions or large polyps that need to be removed as a whole.
Advantages and disadvantages of endoscopic mucosal resection
Similar to other endoscopic surgical methods, endoscopic mucosal resection also benefits patients by not requiring complicated invasive surgery.
| Advantages | Disadvantages |
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Comparing EMR and ESD
Here is a table comparing the two methods EMR and ESD. The choice of method will depend on the size, type of lesion, and the physician’s ability to perform the procedure.
| Factor | EMR (Endoscopic Mucosal Resection) | ESD (Endoscopic Submucosal Dissection) |
| Method | Mucosal resection using a metal snare loop | Submucosal dissection, en bloc resection |
| Application | Small, superficial lesions, under 2cm | Large, deep lesions, early-stage cancer |
| Removal ability | Only removes superficial mucosa | Removes the entire lesion, including the submucosa |
| Technique | Simpler, quicker to perform | More complex, requires high skill |
| Complications | Bleeding, recurrence if not completely removed | Bleeding, perforation, infection (requires skilled doctor) |
| Recurrence rate | Higher if not completely removed | Lower, complete en bloc removal of the lesion |
Indications for endoscopic submucosal dissection
Subjects indicated for endoscopic submucosal dissection include subjects requiring endoscopic mucosal resection.
- Early-stage cancer: ESD is commonly indicated for patients with early-stage gastrointestinal cancer, where the cancer is still confined to the mucosa or submucosa and has not invaded deeper layers or surrounding tissues.
- Large polyps or precancerous lesions: ESD can be indicated for large polyps or precancerous lesions that cannot be completely removed by EMR (Endoscopic Mucosal Resection) or are not effectively treated by other methods. Large polyps in the colon, stomach, or esophagus may require en bloc removal to ensure complete removal of the diseased tissue.
- Large or deep mucosal lesions: When mucosal or submucosal lesions are large or complex, ESD allows for en bloc removal and reduces the risk of recurrence compared to EMR.
- Lesions that are not amenable to open surgery: Some lesions may not be suitable for open surgery due to their location, size, or high surgical risk, and ESD offers a less invasive and more effective alternative.
- Lesions in the stomach, colon, or esophagus: Lesions in the mucosa of these organs can be treated with ESD if they are small, medium, or large and can be removed without damaging surrounding healthy tissue.
Conclusion, endoscopic mucosal resection is increasingly developed to help patients. The comparison between mucosal resection and endoscopic submucosal dissection helps patients choose the method that is right for them.
