Management of Gastrointestinal EMR and ESD Perforation: From Lab to Practice

Endoscopic submucosal dissection and endoscopic mucosal resection allow complete resection of flat lesions of the GI tract, as they utilize submucosal fluid injection for lifting that makes lesions accessible for complete resection. However, perforation is a serious risk as these procedures involve cutting the mucosa and submucosa while sparing the deep submucosa and muscularis propria of the rather thin gut wall. Advances in clinical practice as well as investigative work in the animal laboratory have helped us to develop techniques for successful endoluminal closure of such perforations.