Advanced therapeutic endoscopy - The continuing shift towards minimally invasive endoscopic surgery

Advanced therapeutic endoscopy is fully established as a first-line treatment in early gastrointestinal neoplasia and pancreaticobiliary disease. The management of conditions that were formerly restricted to the domain of surgeons is shifting towards minimally invasive endoscopic surgery. Endoscopic treatment replaces the need for major surgery, which is associated with considerable morbidity and mortality. However, these novel endoscopic techniques also come with a risk of complications, such as bleeding, perforation, post-treatment strictures in endoscopic resections and bile leakage or severe pancreatitis, which are associated with morbidity and even mortality. In this article, we discuss the important developments that led to the current status of endoscopic resection and therapeutic endosonography together with their limitations and complications and the development of natural orifice transluminal endoscopic surgery.