Minimally invasive treatment of early gastrointestinal cancers

The diagnostic and therapeutic paradigm of early esophageal, gastric and colorectal cancer is shifting. Historically, surgery was the standard of care for gastrointestinal malignancies, including those at an early stage. However, it is associated with loss of function of the organ, higher morbidity, and associated costs. Endoscopic resection has evolved as a minimally invasive alternative that provides accurate histologic diagnosis, as well as curative resection for many early gastrointestinal malignancies. Endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and the recently described submucosal tunneling endoscopic resection (STER) constitute some of these new resection techniques. Appropriate selection of lesions amenable for endoscopic resection is crucial when being used with curative intent. Estimation of eligibility relies entirely in an adequate pre-procedural evaluation of depth of invasion and histology, which correlate with the risk of lymph node metastasis. Adequate histopathologic examination of the resected specimen determines curability of the resection, guiding the need for further therapy. We will review the indications, outcomes, and limitations of EMR, ESD, and STER.