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Chapter-11 Therapeutic Endoscopy in Gastrointestinal Cancers

BOOK TITLE: Recent Advances in Surgery 33

Author
1. Kumar Sunil
2. Verma Arunima
ISBN
9789380704227
DOI
10.5005/jp/books/11221_11
Edition
1/e
Publishing Year
2010
Pages
22
Author Affiliations
2. Tata Main Hospital, Jamshedpur, India, Tata Main Hospital, Jamshedpur, Jharkhand, India, (UK); Tata Main, Hospital, Jamshedpur, India, Tata Motors Hospital, Jamshedpur, Jharkhand, India, Tata Motors Hospital, Jamshedpur, India
Chapter keywords

Abstract

Endoscopy has a significant role to play in the medical and surgical management of gastrointestinal cancers both in localized and advanced conditions. With the emergence of natural orifice transluminal endoscopic surgery (NOTES), there is renewed interest among surgeons for endoscopy. The diagnostic potentials of endoscopy are already established and with technological advancements and technique refinements, therapeutic endoscopy is making a mark in management—both palliative and curative—in gastrointestinal malignancies. Stents may be used in esophagus, stomach, pancreas, bile ducts and the rectum and colon. Therapeutic endoscopy has both curative and palliative roles in carcinoma of the esophagus. Curative options are ablative therapies and endoscopic mucosal resection (EMR). Endoscopic palliation of esophageal carcinoma mainly consists of the symptomatic relief of dysphagia. Stent is the most commonly used endoscopic palliation technique and is safe and effective for esophageal cancer at any site. Other endoscopic palliation techniques for esophageal cancer are alcohol injection, laser therapy, APC, PDT and brachytherapy. EMR for EGC is a curative technique and avoids surgery and its potential complications. Enteral stents, laser therapy and APC are used for palliation of GOO. The location of biliary obstruction is important with regards to palliative approach. Endoscopic palliation is indicated for cholangitis and pruritus due to cholestasis and is provided by ERCP stenting. The use of plastic stents is nowadays recommended in patients with poor prognosis with life expectancy less than 5–6 months. SEMS should be used in patients expected to survive longer than six months. Endoscopic pancreatic stenting should be considered for obstructive pain not responding to analgesics in selected patients. Hilar obstruction may be treated with ERCP stenting and PDT if PTC is not available. Endoscopy is used for surveillance, prevention of premalignant lesions turning into malignant, palliation of malignant bowel obstruction and curative resection in colorectal malignancy. Endoscopic treatment of colorectal malignant polyps and adenomas includes polypectomy, EMR and ESD. Endoscopic palliation for malignant large bowel obstruction can be achieved by colonic decompression tubes, self-expanding metal stents, laser therapy and APC.

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