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World J Gastrointest Endosc. Apr 16, 2015; 7(4): 370-380
Published online Apr 16, 2015. doi: 10.4253/wjge.v7.i4.370
Multiband mucosectomy for advanced dysplastic lesions in the upper digestive tract
Jesús Espinel, Eugenia Pinedo, Vanesa Ojeda, Maria Guerra del Rio
Jesús Espinel, Department of Digestive Diseases, Hospital Universitario de León, 24071 León, Spain
Eugenia Pinedo, Department of Radiodiagnosis, Hospital Universitario de León, 24071 León, Spain
Vanesa Ojeda, Department of Digestive Diseases, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, 35010, Spain
Maria Guerra del Rio, Burton Hospitals NHS Foundation Trust, Burton on Trent, Staffordshire DE13 0RB, United Kingdom
Author contributions: All authors contributed equally to the paper.
Conflict-of-interest: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jesús Espinel, MD, Department of Digestive Diseases, Hospital Universitario de León, C/ Altos de Nava, s/n, 24071 León, Spain. espinel.jesus@gmail.com
Telephone: +34-987-237400 Fax: +34-987-235318
Received: August 8, 2014
Peer-review started: August 8, 2014
First decision: November 28, 2014
Revised: December 20, 2014
Accepted: January 15, 2015
Article in press: January 19, 2015
Published online: April 16, 2015
Processing time: 254 Days and 8.8 Hours
Abstract

Endoscopic resection (ER) is at present an accepted treatment for superficial gastrointestinal neoplasia. ER provides similar efficacy to surgery; however, it is minimally invasive and less expensive. Endoscopic mucosal resection (EMR) is superior to biopsy for diagnosing advanced dysplasia and can change the diagnostic grade and the management. Several EMR techniques have been described that are alternatively used dependent upon the endoscopist personal experience, the anatomic conditions and the endoscopic appearance of the lesion to be resected. The literature suggests that EMR offers comparable outcomes to surgery for selected indications. EMR techniques using a cap fitted endoscope and EMR using a ligation device [multiband mucosectomy (MBM)] are the most frequently use. MBM technique does not require submucosal injection as with the endoscopic resection-cap technique, multiple resections can be performed with the same snare, pre-looping the endoscopic resection-snare in the ridge of the cap is not necessary, MBM does not require withdrawal of the endoscope between resections and up to six consecutive resections can be performed. This reduces the time and cost required for the procedure, while also reducing patient discomfort. Despite the increasing popularity of MBM, data on the safety and efficacy of this technique in upper gastrointestinal lesions with advanced dysplasia, defined as those lesions that have high-grade dysplasia or early cancer, is limited.

Keywords: Endoscopic mucosal resection; Barrett’s esophagus; Esophageal cancer; Early gastric cancer; Stepwise radical endoscopic resection; Multiband mucosectomy; Endoscopic submucosal dissection

Core tip: Early detection of upper gastrointestinal lesions with advanced dysplasia is especially important in the management of the patients. These changes may indicate an increased risk of cancer or may detect cancer at an earlier stage, when it can be more effectively treated. Multiband mucosectomy (MBM) is an easy endoscopic mucosal resection technique allowing a definitive histologic diagnosis and potentially being curative. The available evidence suggests that MBM for these conditions, has an initial success rate comparable to surgical treatment, but with fewer complications.