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Review
. 2022 Apr 25:7:19.
doi: 10.21037/tgh-2020-10. eCollection 2022.

Advances in endoscopic resection: a review of endoscopic submucosal dissection (ESD), endoscopic full thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER)

Ishita Dalal  1 , Iman Andalib  2
Affiliations
Review

Advances in endoscopic resection: a review of endoscopic submucosal dissection (ESD), endoscopic full thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER)

Ishita Dalal et al. Transl Gastroenterol Hepatol. .

Abstract

Subepithelial lesions are often detected incidentally in patients undergoing an endoscopy. They are common tumors of the gastrointestinal (GI) tract which can originate from different layers of the GI tract wall. These lesions can be further classified based on GI layer of origin and unique histochemical staining. While most are benign and asymptomatic, some of these lesions have malignant potential with distant metastases. However, current diagnostic modalities including endoscopy with biopsy or endoscopic ultrasound with fine needle aspiration are not always reliable. In addition, management of these lesions has historically involved surgical resection via open or laparoscopic approaches. In recent years, with advancement in endoscopic techniques and improvement in endoscopists' skills, less invasive procedures such as endoscopic submucosal dissection (ESD), endoscopic full thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER) have been developed and now are being used by endoscopists worldwide. Upon reviewing the literature, multiple studies have shown the advantages of these endoscopic techniques when compared with surgical treatment. As a result, there has been a dramatic shift towards minimally invasive endoscopic procedures for the management of these subepithelial lesions. In this review article, we will discuss these endoscopic resection techniques in detail, their safety and efficacy, as well as comparison studies to other therapeutic modalities.

Keywords: Subepithelial lesions; endoscopic full thickness resection (EFTR); endoscopic submucosal dissection (ESD); submucosal tunneling endoscopic resection (STER).

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Conflict of interest statement

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://tgh.amegroups.com/article/view/10.21037/tgh-2020-10/coif). The series “Innovation in Endoscopy” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Endoscopic submucosal dissection. (A) Submucosal lesion noted in the gastric body; (B) lifting and submucosal dissection of the lesion; (C) gastric defect after complete resection; (D) closure of the defect with endoscopic suturing; (E) submucosal lesion post removal.
Figure 2
Figure 2
Endoscopic full thickness resection. (A) Submucosal lesion noted in the gastric fundus and marked; (B) circumferential dissection of lesion leaving a defect; (C) closure of defect with suturing device.
Figure 3
Figure 3
Submucosal tunneling endoscopic resection. (A) Endoscopy showing the submucosal lesion in the fundus; (B) submucosal tunneling with injection of methylene blue as well as electrosurgical knife; (C) the lesion being dissected from the deeper layer of muscularis propria; (D) closure of the defect with endoscopic suturing.
See this image and copyright information in PMC

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