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PubMedDate not supplied

Approaches to the endoscopic treatment of esophageal varices.

Endoscopic therapy is commonly employed for both initial and subsequent definitive treatment of variceal bleeding. Sclerotherapy performed with a flexible endoscope is currently the most widespread technique. Available data suggests that such treatment does not improve outcome in the acute treatment of variceal bleeding (first 30 days) but appears superior to conventional medical management in the long term. Sclerotherapy does not appear better or worse than pharmacological therapy or surgical therapy when these treatments are compared in the elective setting. Although effective, endoscopic sclerotherapy is recognized to be associated with many major and minor treatment-related complications and a significant incidence of recurrent hemorrhage. In response to these shortcomings newer forms of endoscopic therapy such as polymer injection and endoscopic ligation have been developed. Polymer injection appears well suited for patients with active bleeding and for those with gastric varices but does not have advantages for chronic treatment aimed at variceal eradication. Endoscopic ligation appears at least as effective as conventional sclerotherapy for control of acute bleeding and prevention of rebleeding and is associated with few treatment induced complications. While endoscopic therapy will likely continue as the most commonly employed treatment for patients with hemorrhage from esophageal varices, newer methods with wider margins of safety and efficacy seem destined to supplement or replace conventional endoscopic sclerotherapy.

Esophageal and Gastric Varices↗
PubMedDate not supplied

Laser-assisted endoscopic reduction malarplasty in Asians: quick combined surgery.

Removal of unwanted prominent cheek bones is of major importance to Korean women for correction of their unfavorable impression. We usually use a endoscope for reducing the external scar, but in endoscopic bone contouring surgery, it is important to prevent any damage to surrounding soft tissue during osteotomy and to control bleeding, without any facial nerve damage, with a clean endoscopic visual field. We used endoscopic surgery equipment, an ultrashort-pulsed endoscopic contact Nd-Yag laser (Japan SLT), and various laser fiber tips and osteotomes. Twenty-one patients who underwent laser-associated endoscopic reduction malarplasty with more than 1 year of follow-up were evaluated. Compared to conventional endoscopic osteotomy, this combined procedure was found to be safe and effective in endoscopic reduction malarplasty, due to the clean visual field and excellent hemostasis provided.

Adult↗
PubMed2003

Endosonography of upper gastrointestinal tract cancer on demand using miniprobes or endoscopic ultrasound.

BACKGROUND: The aim of this study was to investigate whether endosonography on demand with miniprobes and conventional endoscopic ultrasound improves the accuracy of endosonographic staging of upper gastrointestinal tract cancer. METHODS: Altogether, 173 patients underwent endoscopic ultrasonography for preoperative staging of esophageal (n = 63) or gastric cancer (n = 110). Depending on the endoscopic appearance (i.e., size and growth pattern), tumors were examined with a linear-array echoendoscope (7.5 MHz) or with high-resolution miniprobes (12.5 MHz). The results of preoperative staging were correlated with histopathology of the resection specimen. RESULTS: The overall accuracy of miniprobe ultrasonography and endoscopic ultrasound in assessing the infiltration depth of upper gastrointestinal cancer was 87% and 81%, respectively. Miniprobe ultrasonography was superior to conventional endoscopic ultrasound in the staging of early cancers, particularly T1 tumors (accuracy, 81% vs 56%). The combined accuracy of both techniques for all tumor stages was 82%. Correct diagnosis of lymph node involvement was obtained with miniprobe ultrasonography or endoscopic ultrasound in 76% and 71% of the cases, respectively. The combined accuracy in assessing the lymph node status was 73% (sensitivity, 68%; specificity, 81%). CONCLUSIONS: Endosonography on demand using either miniprobes or conventional endoscopic ultrasound may result in more effective and less invasive staging of esophageal and gastric cancer. Selective use of high-resolution miniprobes and conventional endoscopic ultrasound offers accurate staging of all tumor stages.

Adult↗
PubMed2003

Endoscopic treatment of benign gastrointestinal anastomotic strictures using argon plasma coagulation in combination with diathermy.

BACKGROUND: Initially, treatment for anastomotic strictures was surgical. Currently. however, endoscopic techniques are preferred. This study aimed to investigate the efficiency and safety of endoscopic treatment using argon plasma coagulation in combination with diathermy. METHODS: From 1995 to 2000, 49 patients with postsurgical anastomotic strictures of the esophagus or colon were referred for endoscopic treatment. In all cases, radiologic and endoscopic examination showed membranous or short strictures (diameter, 3-8 mm). Under direct endoscopic control, the scar tissue at the anastomotic line was incised radially with a polypectomy snare. The scar tissue between the incisions then was reduced carefully by argon plasma coagulation. RESULTS: All 49 patients were treated successfully with this combined endoscopic technique. Only for four patients was more than one endoscopic session (mean, 3.5; range, 2-6) needed to guarantee long-term success. No complications were encountered. CONCLUSIONS: Endoscopic argon plasma coagulation in combination with diathermy is a safe and effective technique for the treatment of short postsurgical gastrointestinal anastomotic strictures.

Adolescent↗
PubMed2006

Transgastric endoscopic splenectomy: is it possible?

BACKGROUND: We have previously reported the feasibility of diagnostic and therapeutic peritoneoscopy including liver biopsy, gastrojejunostomy, and tubal ligation by an oral transgastric approach. We present results of per-oral transgastric splenectomy in a porcine model. The goal of this study was to determine the technical feasibility of per-oral transgastric splenectomy using a flexible endoscope. METHODS: We performed acute experiments on 50-kg pigs. All animals were fed liquids for 3 days prior to procedure. The procedures were performed under general anesthesia with endotracheal intubation. The flexible endoscope was passed per orally into the stomach and puncture of the gastric wall was performed with a needle knife. The puncture was extended to create a 1.5-cm incision using a pull-type sphincterotome, and a double-channel endoscope was advanced into the peritoneal cavity. The peritoneal cavity was insufflated with air through the endoscope. The spleen was visualized. The splenic vessels were ligated with endoscopic loops and clips, and then mesentery was dissected using electrocautery. RESULTS: Endoscopic splenectomy was performed on six pigs. There were no complications during gastric incision and entrance into the peritoneal cavity. Visualization of the spleen and other intraperitoneal organs was very good. Ligation of the splenic vessels and mobilization of the spleen were achieved using commercially available devices and endoscopic accessories. CONCLUSIONS: Transgastric endoscopic splenectomy in a porcine model appears technically feasible. Additional long-term survival experiments are planned.

Animals↗
PubMed2001

Endoscopic-assisted subcutaneous mastectomy and axillary dissection with immediate mammary prosthesis reconstruction for early breast cancer.

BACKGROUND: Endoscopic surgery has been applied successfully in breast lump excision, breast augmentation, subcutaneous mastectomy for gynecomastia, and axillary dissection. Since subcutaneous mastectomy has been proven to be oncologically safe for early breast cancer, we have sought to develop a reproducible minimally invasive endoscopic-assisted technique to address this condition. METHODS: Between December 1998 and May 1999, endoscopic-assisted subcutaneous mastectomy and axillary dissection with immediate reconstruction using a mammary prosthesis was performed in nine patients with early breast cancer at the Prince of Wales Hospital, Hong Kong. A 5-cm skin incision was made along the line of the lowest axillary skin crease. Dissection was continued down to the lateral border of the pectoralis major muscle. A subpectoral pocket was gently created by an endoscopic breast dissector. The endoscopic breast retractor and 10-mm/30 degrees scope were introduced into the subpectoral pocket, and further dissection was carried out using a 7-in harmonic scalpel under endoscopic vision down to a level 1 cm caudal to the inframammary fold. This subpectoral space was used for the insertion of the mammary prosthesis later on. Endoscopic-assisted subcutaneous mastectomy was performed afterward. Combined level I and level II axillary dissection was carried out via the same incision under direct vision. RESULTS: Apart from minor skin flap bruises in our first two patients, there were no major complications. Histological examination of all the specimens showed clear margins. Postoperative radiotherapy and chemotherapy were given in the usual manner. All patients were satisfied with the reconstructive outcome. CONCLUSIONS: We have described a novel endoscopic technique for subcutaneous mastectomy with immediate mammary prosthesis reconstruction in treating early breast cancer patient. This technique can minimize skin incision, reduce blood loss, and improve reconstructive outcome. It is easy to learn and well accepted by patients.

Adult↗
PubMed2001

Endoscopic ligation for patients with active bleeding Mallory-Weiss tears.

BACKGROUND: Only a few patients with active nonesophageal variceal upper gastrointestinal bleeding have been treated with endoscopic ligation. To further address this issue, four patients with active bleeding Mallory-Weiss tears who underwent endoscopic band ligation are presented. PATIENTS AND METHODS: Endoscopic ligation was performed in four patients with a median age of 52 years (range, 40-93 years) after a diagnosis of active bleeding Mallory-Weiss tears (MWTs). A 45-year-old man with massive persistent upper gastrointestinal bleeding as a cause of a MWT underwent therapeutical endoscopic band ligation after an unsuccessful endoscopic injection trial. On the contrary, injection therapy should have been performed on a 93-year-old woman with multiple myeloma because of an actively bleeding MWT caused by the fibrotic tissue after an unsuccessful endoscopic ligation trial, although her other actively bleeding MWT lesion had been ligated successfully. RESULTS: After endoscopic ligation, all patients achieved complete hemostasis, and rebleeding did not occur. They were discharged without complications after a control endoscopy. CONCLUSIONS: Endoscopic ligation can be performed easily and without any complications such as perforation or delayed hemorrhage in patients with actively bleeding nonfibrotic MWTs.

Adult↗
PubMed2004

Robot-assisted navigated endoscopic ventriculostomy: implementation of a new technology and first clinical results.

BACKGROUND: Important landmarks in the evolution of advanced neurosurgical techniques during the past decades include microneurosurgery, neuro-endoscopy and its minimally invasive nature, as well as neuronavigation and advanced intra-operative imaging. With conventional neuroendoscopic techniques, e.g. free-hand endoscopy or the use of mechanical or pneumatic holding devices, a definitive and controlled movement of the endoscope within the brain does depend on the experience and manual skill of the individual neurosurgeon. Therefore, the development of robotic systems to assist surgeons in performing complex neurosurgical procedures is a growing field of interest. METHOD: With the precision robot "Evolution 1" (U.R.S. Universal Robot Systems, Schwerin, Germany) a new neurosurgical tool has just become available for the precise steering of instruments within the cranium. After preclinical anatomical as well as precision studies the system was used for robot-assisted navigated endoscopic third ventriculostomies in six patients with hydrocephalus related to aqueductal stenosis. FINDINGS: All robot-assisted navigated endoscopic procedures were successfully completed. The time for the registration procedure and setup of the robot decreased from 60 min. for the first procedure down to 30 min. The time for the surgical part of the neuro-endoscopic procedure itself ranged from 17 to 35 min. During all procedures no system-related complications occurred. INTERPRETATION: The use of robotic technology for neuro-endoscopic third ventriculostomies is a major step towards the controlled movement of the neuro-endoscope within the cranium. The start up procedure and calibration of the robot is still time consuming, but the real operation time is comparable to free hand neuro-endoscopy. The steering of the endoscope is facilitated and the precision of the endoscopic movements is noteworthy.

Adolescent↗
PubMed2004

Systemic inflammatory response after endoscopic (TEP) vs Shouldice groin hernia repair.

Endoscopic techniques are commonly used for many different types of surgery. It is claimed that videoendoscopic procedures have the advantage of being less traumatic and of offering higher postoperative patient comfort than conventional open techniques. The extent of tissue trauma can be evaluated on the basis of the inflammatory response observed in the wake of surgery. Available studies that have compared endoscopic and conventional techniques suggest that endoscopic cholecystectomy, laparoscopic colorectal resection, and thoracoscopic pulmonary resection have immunologic advantages over conventional approaches. The objective of this prospective study was to determine whether endoscopic hernia repair techniques are also preferable to conventional procedures and to what extent the anesthetic technique (local or general anesthesia) influences the postoperative inflammatory response. For this purpose, biochemical monitoring of cytokine activity [C-reactive protein (CRP), prostaglandin F1alpha (PGF1alpha), neopterin, interleukin-6 (IL-6)] was done prospectively in 101 patients [totally extraperitoneal approach (TEP) n=32, unilateral n=12, bilateral n=20; Shouldice n=69, local anesthesia (LA) n=23, general anesthesia (GA) n=46] before and until 3 days after surgery. The parameters IL-6 and PGF1alpha suggested that the immune trauma immediately after surgery was significantly higher in the group of patients with endoscopic hernia repair than in the group of patients who received a Shouldice repair. No significant differences were observed after the first postoperative day. A comparison between the TEP group and the patients who received conventional surgery under local anesthesia showed that the TEP approach was also associated with a higher postoperative neopterin level. Within the first 3 days after surgical intervention, bilateral endoscopic hernia repair induced no significantly higher inflammatory response than the surgical treatment of unilateral conditions. The anesthetic procedure that was used in the Shouldice operation had no significant effect on inflammatory response. Unlike other types of endoscopic surgery, the repair of groin hernias using an endoscopic technique cannot be regarded as a minimally invasive procedure that is less traumatic than conventional approaches. Instead, the conventional Shouldice procedure appears to cause the lowest inflammatory response and to be the least traumatic approach to hernia repair, especially when it is performed under local anesthesia.

Adolescent↗
PubMed2004

Endoscopic totally extraperitoneal repair of incarcerated inguinal hernia.

BACKGROUND: Incarcerated inguinal hernias have been considered a relative contraindication for endoscopic surgery, as its efficacy and safety is as yet unproven. With more experience and improved techniques, management of incarcerated hernias by the endoscopic approach has become possible with decreased patient discomfort and acceptable results. AIM AND OBJECTIVE: To analyze the feasibility and effectiveness of Endoscopic Totally Extraperitoneal repair in incarcerated inguinal hernias. METHODS: We retrospectively analyzed 34 patients-admitted under a single surgical unit with chronically incarcerated inguinal hernias-who underwent an elective endoscopic totally extraperitoneal repair. The 6-year period studied was from May 1997 to May 2003. Demographic characteristics, operative details (including modifications in technique and use of drains) and postoperative outcome including analgesic requirements, hospital stay, complications, and time taken to resume normal activity, were evaluated. A comparison was made with the results of 286 endoscopic primary, non-incarcerated, unilateral endoscopic totally extraperitoneal hernia repairs done during the same period. RESULTS: With the help of modified techniques for reduction of the hernial sac, all the patients underwent a successful TEP repair. There were no conversions. The mean operating time was 84.4 min compared to 57 min in the non-incarcerated group. Three-fourths of the patients could be discharged within 24 h. Analgesic requirement was for an average of 5.5 days (vs 4.2 days in the non-incarcerated group). Time taken to resume normal activity was 7.5 days (vs 5.6 days in the non-incarcerated group). Two recurrences occurred. Follow-up period ranged from 13 months to 84 months. CONCLUSIONS: With the help of modifications in operating technique, Endoscopic Totally Extraperitoneal repair is feasible and effective in patients with incarcerated inguinal hernias and encompasses the advantages of endoscopic procedures.

Adult↗
PubMed2006

The learning curve in endoscopic pituitary surgery and our experience.

Experience is the important point in reduction of the complications and in the effectiveness of the surgical procedure in pituitary surgery. Endoscopic pituitary surgery differs from microscopic surgery, since it requires a steep learning curve for endoscopic skills. In this article, we evaluate our learning curve in two groups, as early and late experience. Purely endoscopic transsphenoidal operations were performed on 78 patients, which were retrospectively reviewed and grouped as early and late experience groups. We used the purely endoscopic endonasal approach to the sella that was performed via an anterior sphenoidotomy, without the use of a transsphenoidal retractor. All patients with adenomas were evaluated considering operation time, endocrinology, ophthalmology, total removal and, especially, modifications of standard technique. On the basis of the experience gained with the use of the endoscope in transphenoidal surgery over the years, modifications can be performed on the different phases of the endoscopic approach. Reviewing our cases in two groups of period due to our experience showed that the effectiveness of endoscopic surgery increases and operation time decreases. In our study, we identified a learning curve in endoscopic pituitary surgery.

Adenoma↗
PubMed2006

Experience of endoscopic transanal resections with a urologic resectoscope in 131 patients.

PURPOSE: Endoscopic transanal resection of rectal adenomas and other presumably benign lesions is not widespread. The purpose of this study was to evaluate the efficacy and the safety of endoscopic transanal resection. METHODS: Patients who underwent endoscopic transanal resection at three Stockholm hospitals between 1993 and 2004 were studied retrospectively with respect to patient and lesion characteristics, complications, follow-up time, and recurrence rates. RESULTS: One hundred eighty endoscopic transanal resection procedures were performed in 131 patients. The tissue diagnosis was adenoma in 160 operative cases, cancer in 12 operative cases, and hyperplasia, fibrosis, or normal mucosa in the remaining 8 operative cases. Among the patients with rectal adenomas, one endoscopic transanal resection was sufficient in 77 cases and in 16 cases the surgery was performed in more than one session because of the large size of the adenoma. In 27 cases there were recurrences that needed additional endoscopic transanal resection or other surgery. The median time until recurrence was seven months, but there were no recurrent rectal carcinomas. In 16 operative cases there were complications. Two patients had to undergo a Hartman's procedure as a result of a bowel perforation, and one patient had to be reoperated on because of bleeding. There were no perioperative deaths. The median follow-up time without recurrence was 32 (range, 0-67) months. CONCLUSIONS: Endoscopic transanal resection is a feasible and oncologically safe option for treatment of rectal adenomas, especially in cases where conventional transanal resection or transanal endoscopic microsurgery are unavailable or unsuitable because of the characteristics and localization of the lesion.

Adenoma↗
PubMed2006

A novel method of endoscopic mucosal resection assisted by submucosal injection of autologous blood (blood patch EMR).

PURPOSE: Endoscopic mucosal resection assisted by submucosal injection of saline is a widely used procedure; however, it has three limitations: 1) it often is difficult to maintain a desirable level of tissue elevation after the injection; 2) the saline has no efficacy in preventing hemorrhage; 3) nothing can protect the site of mucosal defect after endoscopic mucosal resection to prevent perforation. Blood, as a new medium for use in submucosal injection, may remedy these drawbacks. This is the first report of this technique. METHODS: From May to October 2004, 28 outpatients (8 females; median, 64 years) with 35 colorectal polyps (median, 5 mm in diameter; range, 1-30 mm) were enrolled in this study. Technique of the blood patch endoscopic mucosal resection: after autologous blood was injected into the submucosa under the lesion using a disposable 23-gauge needle, the lifted mucosa with the lesion was removed using a conventional snaring technique. The outcomes were prospectively studied. RESULTS: Although one lesion was not lifted by the submucosal injection because of the submucosal invasion of carcinoma, 33 of the other 34 lesions (97.1 percent) were successfully completed using the blood patch endoscopic mucosal resection. The clot covered the raw surface after the endoscopic mucosal resection without bleeding. No complications (including hemorrhage and perforation) were observed. The blood patch endoscopic mucosal resection did not disturb pathologic examination. CONCLUSIONS: Endoscopic mucosal resection assisted by submucosal injection of autologous blood can be performed safely, easily, and economically. Autologous blood is a promising medium for submucosal injection on endoscopic mucosal resection.

Aged↗
PubMed2005

Proposal of a new clinical index predictive of endoscopic severity in ulcerative colitis.

Assessment of disease activity by clinical parameters in ulcerative colitis is still controversial. Different clinical indexes have been proposed. Colonoscopy provides detailed information on mucosal damage. The aim of this study was to identify, among 21 clinical and laboratory parameters, which were predictive of endoscopic activity. We included 137 consecutive patients with ulcerative colitis who underwent colonoscopy, clinical examination, and blood tests within 4 weeks. Endoscopic severity was recorded using a simple score (range, 0-30). The multiple stepwise regression coefficient of each significant variable predictive of mucosal damage was used to develop a new activity index predictive of endoscopic appearance (Endoscopic-Clinical Correlation Index; ECCI). We tested the ability of our score to discriminate patients with severe endoscopic disease, calculating the area under the receiver operator characteristic curve, and we compared it to activity indexes proposed by other authors. Endoscopic severity was significantly influenced by four parameters: bloody stool, nocturnal bowel movements, body temperature >37.5 degrees C, and serum albumin. The new scoring system was calculated as ECCI = {[serum albumin x (-26)] + (bloody stool x 17) + (nocturnal bowel movements x 16) + [fever (0 or 1) x 39]} + 107. The ECCI accurately identified patients with severe endoscopic disease in our sample (sensitivity = 81%, specificity = 95%). In conclusion, the ECCI should be useful in clinical practice because it is simple and strongly related to endoscopic activity.

Adult↗
PubMed2003

Endoscopic Interventions in the Biliary Tract.

In patients with common bile duct stones, the endoscopic removal of such stones has become the standard therapy. The surgical approach is indicated only for stones that cannot be extracted endoscopically. In biliary obstruction due to pancreaticobiliary malignancy, endoscopic interventions represent the first-line therapy in the palliative situation. If endoscopic access is not possible, the percutanous approach often represents an alternative, followed by palliative surgical options. Biliary strictures or bile leaks after liver transplantation very often may be treated effectively by endoscopic dilatation or temporary stenting. In most cases, endoscopic therapy of such problems represents the first option before the percutaneous or surgical approach is indicated. In primary sclerosing cholangitis, dominant biliary strictures develop frequently and endoscopic treatment allows their opening in most cases. There is no real alternative to endoscopy in this situation. The situation is more complex in postoperative biliary strictures and chronic pancreatitis. In these conditions, advantages and disadvantages of the endoscopic versus the surgical approach have to be evaluated to find the most effective form of treatment in the individual situation. The surgical intervention often represents the better alternative.

Journal Article↗
PubMed1992

Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis.

Endoscopic hemostatic therapy for upper gastrointestinal bleeding is gaining widespread acceptance despite often conflicting results of randomized controlled trials. To examine the effect of endoscopic therapy in acute nonvariceal upper gastrointestinal hemorrhage, a meta-analysis was performed using a computerized search of the English-language literature and a bibliographic review. The methodology, population, intervention, and outcomes of each relevant trial were evaluated by duplicate independent review. Thirty randomized controlled trials evaluating hemostatic endoscopic treatment were identified. Endoscopic therapy significantly reduced rates of further bleeding (odds ratio, 0.38; 95% confidence interval, 0.32-0.45), surgery (odds ratio, 0.36; 95% confidence interval, 0.28-0.45), and mortality (odds ratio, 0.55; 95% confidence interval, 0.40-0.76). When analyzed separately, thermal-contact devices (monopolar and bipolar electrocoagulation and heater probe), laser treatment, and injection therapy all significantly decreased further bleeding and surgery rates. The reductions in mortality were comparable for all three forms of therapy, but the decrease reached statistical significance only for laser therapy. Further examination of subgroups indicated that endoscopic treatment decreased rates of further bleeding, surgery, and mortality in patients with high-risk endoscopic features of active bleeding or nonbleeding visible vessels. Rebleeding was not reduced by endoscopic therapy in patients with ulcers containing flat pigmented spots or adherent clots. Endoscopic hemostatic therapy provides a clinically important reduction in morbidity and mortality in patients with acute nonvariceal upper gastrointestinal hemorrhage.

Acute Disease↗
PubMed1992

Staging of pancreatic and ampullary carcinoma by endoscopic ultrasonography. Comparison with conventional sonography, computed tomography, and angiography.

In a prospective study, endoscopic ultrasonography was compared with transabdominal ultrasonography, computed tomography, and angiography in 60 consecutive patients with pancreatic (n = 46) and ampullary (n = 14) cancer considered to be candidates for surgery. The diagnostic value of these imaging procedures in determining local resectability was assessed. The diagnosis of ampullopancreatic malignancy was made by operation (n = 40) or puncture/biopsy (n = 20). In the 40 patients who underwent surgery, endoscopic ultrasonography was significantly superior to abdominal ultrasonography and computed tomography in determining tumor size and extent and lymph node metastases of pancreatic and ampullary cancer. Furthermore, involvement of the portal venous system as judged by histopathology or surgical exploration was correctly assessed by endoscopic ultrasonography in 95%, whereas angiography (85%), computed tomography (75%) and abdominal ultrasonography (55%) were less sensitive. Of 11 cases of portal venous infiltration found at surgery, endoscopic ultrasonography correctly predicted 10, abdominal ultrasonography only 1, computed tomography 4, and angiography 5 (P less than 0.05 for all three comparisons). Twenty patients did not undergo surgery for different reasons: of those, 9 patients were excluded from operation because of portal venous involvement as shown by angiography. Endoscopic ultrasonography detected portal venous invasion in all these cases. In contrast to the venous system, arterial encasement was less reliably detected by endoscopic ultrasonography. In conclusion, endoscopic ultrasonography is the most effective single imaging procedure for local tumor staging in pancreatic and ampullary cancer. Thus, endoscopic ultrasonography will improve the assessment of tumor resectability and further decrease the need for explorative laparotomy.

Adult↗
PubMed2005

Endoscopic therapy of early gastric cancer.

Endoscopic therapy of early gastric cancer is applicable for differentiated-type mucosal carcinomas that have an extremely low potency of lymph-node metastasis. Among various kinds of endoscopic therapy, endoscopic mucosal resection is the most recommended procedure, because pathological evaluation of affected tissues is available using this method. Recently, endoscopic submucosal dissection, a novel method of endoscopic mucosal resection, has gained interest as a more reliable therapeutic procedure. In the present chapter several issues will be presented on endoscopic therapy for early gastric cancer, including endoscopic diagnosis of early gastric cancer, currently accepted indications of endoscopic therapy, and the possibility of extending the indication and techniques used for mucosal resection.

Dissection↗