Endoscopic Mucosal Resection in the Management of Esophageal Neoplasia: Current Status and Future Directions Vikneswaran Namasivayam, Kenneth K. Wang,

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Presentation transcript:

Endoscopic Mucosal Resection in the Management of Esophageal Neoplasia: Current Status and Future Directions Vikneswaran Namasivayam, Kenneth K. Wang, Ganapathy A. Prasad Clinical Gastroenterology and Hepatology Volume 8, Issue 9, Pages 743-754 (September 2010) DOI: 10.1016/j.cgh.2010.05.030 Copyright © 2010 AGA Institute Terms and Conditions

Figure 1 (A) EMR is performed in superficial lesions with a low risk of nodal metastases. (B) The submucosal injection of saline acts as a cushion separating the mucosa from the muscularis propria. The presence of a lift sign suggests the absence of deeper invasion. (C) The submucosal saline cushion mitigates the risk of deeper injury and perforation during resection. Clinical Gastroenterology and Hepatology 2010 8, 743-754DOI: (10.1016/j.cgh.2010.05.030) Copyright © 2010 AGA Institute Terms and Conditions

Figure 2 Cap EMR. (A) Saline infiltration. (B) Prelooping of snare within the cap. (C) Snare deployment. Clinical Gastroenterology and Hepatology 2010 8, 743-754DOI: (10.1016/j.cgh.2010.05.030) Copyright © 2010 AGA Institute Terms and Conditions

Figure 3 Ligation technique. Deployment of snare over banded mucosa. Clinical Gastroenterology and Hepatology 2010 8, 743-754DOI: (10.1016/j.cgh.2010.05.030) Copyright © 2010 AGA Institute Terms and Conditions

Figure 4 HGD seen in an EMR specimen. Note the nuclear pleiomorphism and the loss of nuclear polarity to the basement membrane. Clinical Gastroenterology and Hepatology 2010 8, 743-754DOI: (10.1016/j.cgh.2010.05.030) Copyright © 2010 AGA Institute Terms and Conditions

Figure 5 Intramucosal EAC seen in an EMR specimen at low power characterized by loss of normal mucosal architecture. Intact muscularis mucosa without invasion of the submucosa. Clinical Gastroenterology and Hepatology 2010 8, 743-754DOI: (10.1016/j.cgh.2010.05.030) Copyright © 2010 AGA Institute Terms and Conditions

Figure 6 Submucosal EAC seen on an EMR specimen. Focus of invasive adenocarcinoma invading the submucosa beneath the muscularis mucosa. Clinical Gastroenterology and Hepatology 2010 8, 743-754DOI: (10.1016/j.cgh.2010.05.030) Copyright © 2010 AGA Institute Terms and Conditions

Figure 7 EMR specimen showing lymphatic invasion by malignant cells. Clinical Gastroenterology and Hepatology 2010 8, 743-754DOI: (10.1016/j.cgh.2010.05.030) Copyright © 2010 AGA Institute Terms and Conditions