Radical treatment of precancerous lesions using modern endoscopic technique

Patient L.H.K., 70 years old, was incidentally discovered to have a gastric lesion during a routine health examination. Endoscopy and biopsy results confirmed that the patient had high-grade epithelial dysplasia (precancerous lesion) in the antrum region.

On magnifying endoscopy, the lesion was approximately 1.5 x 2 cm in size, with clear boundaries, and abnormal surface and vascular patterns. Endoscopic ultrasound (EUS) showed that the lesion was still confined to the mucosal layer, had not invaded the submucosal layer, and no regional lymph nodes were detected.

Dr. Nguyen Thanh Nam, the person who directly performed the ESD intervention, explained the procedure to the patient's family.

Before the case, the Institute of Gastroenterology organized a consultation with the Interventional Gastroenterology Council, with the participation of the Center for Digestive Surgery and the Institute of Diagnostic and Interventional Radiology.

Based on the characteristics of the lesion being localized with clear boundaries, the council agreed to apply the recommendations of the European Society of Gastrointestinal Endoscopy (ESGE) and the Japanese Gastric Cancer Association (JGCA), indicating the performance of ESD to completely remove the lesion via endoscopy, preserving the stomach and avoiding a major surgery.

Dr. Nguyen Thanh Nam and the team prepare for the intervention for the patient.

The procedure was performed by MSc. Dr. Nguyen Thanh Nam, a physician with extensive experience in endoscopic intervention for gastrointestinal tumors. The entire lesion was resected en bloc via endoscopy, with no complications occurring during the intervention.

After the procedure, the patient was monitored and treated at the Department of Gastroenterology - Hepatology, Bach Mai Hospital - Ninh Binh Branch. The patient's health is currently stable, with no abdominal pain, no bleeding, a normal diet, and they are expected to be discharged as planned. The specimen has been sent for histopathological examination to determine the nature of the lesion and assess the resection margins.

Dr. Nguyen Hoai Nam (right), Deputy Director of the Institute of Gastroenterology, in charge of the Department of Gastroenterology - Hepatology, Bach Mai Hospital - Ninh Binh Branch, and the team are closely monitoring the treatment process.

Dr. Nguyen Hoai Nam (right) - Deputy Director of the Institute of Gastroenterology, in charge of the Department of Gastroenterology - Hepatology, Bach Mai Hospital - Ninh Binh Branch, standing side-by-side with the team from the very first steps.

Expanding opportunities for access to high-level techniques for the public

According to experts, the outstanding advantage of the ESD technique is its minimally invasive nature, which allows for the resection of the entire lesion as an intact block instead of cutting it into multiple pieces.

Thanks to this, pathologists can fully evaluate the boundaries and the depth of invasion of the lesion, accurately determining the stage of the disease for cases of precancerous lesions and early-stage gastrointestinal cancer.

Compared to open surgery or partial gastrectomy, this technique helps patients experience less pain, reduces the risk of complications, shortens the length of hospital stay, and preserves digestive function almost completely.

Lesion marking technique prior to dissection.

According to Dr. Nguyen Hoai Nam, Deputy Director of the Institute of Gastroenterology, in charge of the Department of Gastroenterology - Hepatology, Bach Mai Hospital - Ninh Binh Branch, the successful implementation of the ESD technique allows local residents to access advanced endoscopic techniques right in their locality, reducing treatment costs and travel time compared to before.

The specimen was resected en bloc, and the endoscopic image after the intervention.

English: Dr. Nguyen Hoai Nam advises that cases of dysplasia or early-stage gastrointestinal cancer indicated for ESD will have their digestive function almost entirely preserved. For this method to achieve maximum effectiveness, it is crucial to detect the disease at an early stage.

Therefore, the public, especially those over 40 years of age or those with risk factors such as chronic gastrointestinal diseases, atrophic gastritis due to Helicobacter pylori infection, or a family history of gastrointestinal cancer, should undergo regular health check-ups and endoscopies for early detection, thereby increasing the opportunities for effective treatment using minimally invasive endoscopic methods.

The success of the first ESD case continues to affirm the capability of mastering high-level techniques at Bach Mai Hospital - Ninh Binh Branch. This is not only a result of the coordination between the Institute of Gastroenterology and relevant units, but also demonstrates the commitment of Bach Mai Hospital to bringing specialized techniques closer to the public, contributing to improving the quality of medical examination and treatment right in the locality.

Article and photos: Le Dat