Indications

EMR is indicated when the malignancy is at an early stage and the risk of lymph node metastasis is absent. The depth of the lesions usually predicts the risk of cancer. However, the pathologic Japanese classification, encompassing three layers of both mucosa (m1, m2, m3) and submucosa (sm1a, b c, sm2, and sm3), is not applied in western countries. Western pathologists define high grade dysplasia (HGD) by cytologic and architectural changes confined to the mucosa. Malignant lesions are those infiltrating the submucosa, but not reaching the muscularis propria. There are differences in the pathologic interpretation between Japanese and western pathologists. Japanese pathologists base diagnosis of cancer on nuclear, cytologic, and glandular architectural abnormalities, whereas western pathologists require the presence of invasion. In the esophagus, infiltration encompassing m1 and m2 stages can be safely resected.

The rate of lymph node metastasis in patients with early gastric cancer (EGC), ranges between 0 and 3%, but when submucosa infiltration is present the rate ranges between 9 to 19%. ECG are classified as follows:

1. Type I (protruded)

2. Type IIa (superficial elevated)

3. Type IIb (superficial flat)

4. Type IIc (superficial depressed)

5. Type III (excavated)

The exclusion criteria for EMR include the following:

1. Poorly differentiated cancer

2. Presence of an ulceration

3. Diameter greater than 20 mm

4. Type IIc greater than 10 mm

5. Poorly demarcated border

6. Appearance of submucosal tumor infiltration

Western ■ Eastern

-

1

1984 1988 1991 1994 1997 2000 2001 2002 August

2003

FIGURE 6-1. Articles on endoscopic mucosal resection in eastern and western countries.

1984 1988 1991 1994 1997 2000 2001 2002 August

2003

FIGURE 6-2. Articles on colorectal endoscopic mucosal resection in eastern and western countries.

1984 1988 1991 1994 1997 2000 2001 2002 August

2003

FIGURE 6-2. Articles on colorectal endoscopic mucosal resection in eastern and western countries.

Sessile colorectal lesions, including "laterally spreading tumors" characterized by low height and superficial growth, flat adenomas without central depression, can be removed by EMR. EMR should not be carried out in the presence of ulceration, depressed lesions, or absence of lifting after submucosal injection. When smla and smlb (upper third of the first sm layer) infiltration is detected, the risk of lymphatic invasion ranges between 10.7 and 19.1%, but if vessel invasion is observed, surgery is mandatory.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

Get My Free Ebook


Post a comment