Lokale endoskopische Ablation von großen Adenomen und Frühkarzinomen im Gastrointestinaltrakt. ESD, EMR oder Rendezvous?

Local endoscopic treatment of large adenomas and early cancers in the gastro-intestinal tract is now well established. At present various methods, such as endoscopic mucosal resection, endoscopic submucosa dissection and combined laparoscopic-endoscopic procedures are available. The decision on which therapy is best depends on the localization of the lesion, general health and physical fitness of patients and the expertise of the endoscopist and surgeons involved. The potential advantages of endoscopic mucosal resection are that it is fairly easy to acquire and is safe. The most relevant disadvantage is that large lesions can only be treated in a piecemeal fashion. Endoscopic submucosal dissection aims to overcome this limitation. However, the procedure is somewhat cumbersome, technically demanding and carries a substantial risk of perforation. In contrast, combined procedures are very labor intensive and expensive, and the risk of stenosis after removal of large areas has to be taken into consideration.