-Review-

Cutting-Edge Technologies for Gastrointestinal Therapeutic Endoscopy

Osamu Goto, Eriko Koizumi, Kazutoshi Higuchi, Hiroto Noda, Takeshi Onda, Jun Omori, Mitsuru Kaise and Katsuhiko Iwakiri

Department of Gastroenterology and Hepatology, Nippon Medical School Hospital, Tokyo, Japan

With advancements in the development of flexible endoscopes and endoscopic devices and the increased demand for minimally invasive treatments, the indications of therapeutic endoscopy have been expanded. Methods of endoscopic treatment used for tissue removal, hemostasis, and dilatation are as follows. Endoscopic submucosal dissection (ESD) is considered the gold standard curative method for removal of gastrointestinal node-negative neoplasms, regardless of their size or the presence of ulcer formation. Laparoscopic endoscopic cooperative surgery (LECS), which incorporates ESD, was introduced for removal of lesions in deeper layers. Another technique is endoscopic full-thickness resection, which is challenging without the assistance of laparoscopy. In terms of hemostasis, management of iatrogenic bleeding after endoscopic treatment is an important issue. Shielding methods and suturing techniques have been introduced for large mucosal defects after ESD, and their efficacy has been investigated clinically. Peroral endoscopic myotomy (POEM) is a new alternative surgical approach for minimally invasive treatment of esophageal achalasia. Furthermore, endoscopic fundoplication after POEM was devised to prevent post-POEM gastroesophageal reflux disease. Many endoscopic treatments, including ESD, LECS, and POEM, have been introduced in Japan. With the aging of the population, more attention will be directed toward therapeutic endoscopy for elderly patients, because it is less invasive. Development of endoscopic treatments with expanded indications is expected.

J Nippon Med Sch 2021; 88: 17-24

Keywords
therapeutic endoscopy, endoscopic submucosal dissection, endoscopic full-thickness resection, peroral endoscopic myotomy

Correspondence to
Osamu Goto, MD, PhD, Department of Gastroenterology and Hepatology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
o-goto@nms.ac.jp

Received, October 20, 2020
Accepted, December 7, 2020