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Les e-mémoires de l'Académie Nationale de Chirurgie

Endoscopie interventionnelle gastro-intestinale : où allons-nous ?Interventional GI endoscopy where are we heading to ?


Séance du mercredi 11 juin 2014 (SÉANCE FRANCO-ALLEMANDE)


AbstractFlexible interventional endoscopy has been able to replace a big part of major surgical interventions such as for the palliation of malignant esophageal or biliary obstruction, the treatment of bile duct stones, GI bleeding etc.. ‘Endoscopic Submucosal Dissection’ (ESD) allows the safe ‘en bloc’ resection of ‘early’ cancers of more than 1.5 cm. Precancerous lesions and well differentiated mucosal cancers can probably be resected irrespective of their size as long as they lift after injection and secondary surgical resections may be limited to risk constellations (G3; L+, V+; sm++). Long tubular resections of widespread high grade dysplasia or multifocal cancers such as in long Barrett’s segments can effectively be treated via tunneling techniques in the esophagus. The risk of stricture formation has been reduced significantly in first trails by high dose immunosuppression or the transplantation of mucosal grafts from the stomach to the esophagus. Large lesions in the rectum of > 70% of the circumference but limited to the mucosal layer can be resected by flexible endoscopy via preserving the lumen and natural functional anatomy especially in the distal rectum. For the future a new species of endoscopist seems to appear at the horizon combining a high expertise in flexible endoscopy, a solid knowledge of surgical anatomy and principles combined with modern imaging and navigation. We have to prepare the future for this fusion of interventional GI endoscopy and minimally invasive surgery.