Endoscopy: From Diagnosis to Therapeutics

Abstract

Two decades ago, gastroenterologists used endoscopy for the diagnosis of Gastrointestinal
(GI) lesions, thereby helping surgeons to localize lesion that necessitated resection and
treatment with surgery. Today, the gastroenterology field has advanced beyond the diagnostic
era and now, a large number of GI lesions can be treated via endoluminal procedures performed
by the gastroenterologist with no need for surgical intervention.
In recent years, the improvement of endoscopic imaging and tools, such as snares,
clips and needles which can be delivered through the endoscope channel, have helped to change
the field of gastroenterology. This allowed for the development and advancement of Endoscopic
Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD). The pioneers
of EMR and ESD were from Japan and the first articles describing these techniques were published
in the 1990s.1,2
Two classification systems are used for describing GI lesions to be considered for
EMR and ESD. One system is the Japanese classification3 and the second is the Paris system,
which was proposed in 2002.4 The Japanese classification was originally developed for early
gastric cancer management, but it can be applied to lesions throughout the GI tract. Once lesions
are classified, EMR can be performed in different GI locations, including the esophagus,
stomach, colon and rectum. When lesions are more complex and beyond the mucosa, ESD can
be performed with careful dissection.