Blair A. Jobe

Endoscopic Resection for Gastric Cancer

Endoscopic resection of early gastric cancer has been a well-established standard therapy in Japan, and it is increasingly accepted in other countries. Accurate evaluation of the lesion with careful endoscopic examination and histologic assessment are critical for appropriate patient selection in order to avoid performing this procedure on patients with high risk of lymph node involvement and metastasis. Currently, endoscopic mucosal resection (EMR) is performed for lesions smaller than 20 mm. En bloc resection is preferred because of the high risk of local recurrence after piecemeal resection, therefore, endoscopic submucosal dissection (ESD) should be considered for lesions larger than 20 mm.

Techniques of Office-Based Endoscopy: Unsedated Transnasal Endoscopy

Esophagogastroduodenoscopy (EGD) has been widely accepted as a diagnostic and therapeutic tool for the evaluation and management of foregut disease. Most of procedures are currently performed under conscious sedation in an outpatient setting to reduce patient discomfort. Conscious sedation, commonly achieved by moderate sedation with analgesia such as fentanyl and midazolam, is a depressed level of consciousness that allows patients to respond purposefully to verbal commands while continuously maintaining their own airway. However, most of the morbidity associated with EGD is related to sedation with narcotics and sedative agents (especially in older patients with cardiopulmonary disease), potentially leading to hypoxia, hypotension, cardiac arrhythmia, and respiratory failure. Sedation also requires the infrastructure and resources of specialized facilities and monitoring both during and after the procedure, which lead to significant associated cost and resource expenditure (direct costs).