Endoscopic mucosectomy: an alternative treatment for superficial XXXX .

@entity1 @entity355 @entity548 @entity5 @entity1544 @entity418 @entity655 @entity420 @entity1141
Recent trends in the management of superficial @entity418 consist of improved detection, pretherapeutic staging and reliable criteria for curative endoscopic therapy. The endoscopic treatment is legitimate when the @entity5 is at an early stage, intra-epithelial or microinvasive (m1 or m2) and N0. @entity5 should not be treated with a curative intent by endotherapy. Concerning @entity1544 , the oriental and occidental pathologists include high-grade @entity1141 in the same group as @entity5 . The distinction is however maintained for @entity420 in the @entity355 . Indications of endoscopic rather than surgical treatment rely on: (1) the small size of the @entity5 (not more than 2 cm in diameter); (2) the endoscopic morphology in the type 0 of the Japanese classification with the flat subtypes IIa and IIb rather than type IIc--there is high risk of submucosal invasion for the polypoid (type I) or ulcerated superficial @entity5 (type III); and (3) the endoscopic ultrasound staging, with confirmed integrity of the @entity655 . The high-frequency (20 MHz) miniprobe is preferred to the standard (7.5 MHz) instrument. The elective procedure for @entity5 eradication is endoscopic mucosectomy. The technique is associated with a 6.8% risk of severe complications ( @entity548 or perforation) and a recurrence rate of 3%-7%. The 5-year survival rate is similar to that of surgery (over 80%). In the small group of @entity1 with superficial @entity418 (less than 10% of the disease) endoscopic treatment may now be proposed in about 30% of cases, surgery is preferred for @entity5 and for @entity5 with a large surface. Areas of high-grade @entity1141 in the @entity355 offer a new and increasing sector of indications. The concurrent endoscopic procedure of destruction--photodynamic therapy--is preferred for the destruction of lesions with poorly delineated limits.
