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Staging before endoscopic resection: EMR and ESD
Epublication WebSurg.com, Feb 2016;16(02). URL: http://websurg.com/doi/lt03enbarthet006
Pre-procedural planning before any endoscopic resection requires the assessment of the lesion. The main criteria which need to be assessed are the following: - depth of invasion of the lesion; - lymph node metastasis; - lateral spread of the tumor; - pit pattern. Routine endoscopy is used to assess tumor size. Tumors can be staged with the use of many classifications, and notably the Paris classification. High-frequency (≥20MHz) endoscopic ultrasonography (EUS) produces an image of the mucosal wall comprising nine separate layers differentiated by their echogenicity. Careful examination of the depth of lesion penetration into the mucosal and submucosal layers is used to determine the risk of lymph node metastases with a greater precision. Pit pattern can be evaluated by means of magnification on endoscopy. Kudos classification is used. Type I: roundish pits Type II: stellar or papillary pits Type III S: small roundish or tubular pits (smaller than type I pits) Type III L: large roundish or tubular pits (larger than type I pits) Type IV: branch-like or gyrus-like pits Type V: non-structured pits