Endoscopic submucosal dissection of early gastric cancer |
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Authors: | Takuji Gotoda Hironori Yamamoto Roy M Soetikno |
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Institution: | (1) Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan;(2) Department of Internal Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan;(3) Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Palo Alto, CA, USA |
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Abstract: | The purpose of this review was to examine a remarkable technical advance regarding the indications for and the technique of
endoscopic resection of early gastric cancer. Endoscopic mucosal resection (EMR) of early gastric cancer with no risk of lymph
node metastasis has been a standard technique in Japan, probably owing to the high incidence of gastric cancer in Japan and
the fact that more than half of Japanese gastric cancer cases are diagnosed at an early stage. Very recently, several EMR
techniques have become increasingly accepted and regularly used in Western countries. Although these minimally invasive techniques
are safe, convenient, and efficacious, they are unsuitable for large lesions in particular. Difficulty in correctly assessing
the depth of tumor invasion and an increase in local recurrence when standard EMR procedures are used have been reported in
cases of large lesions, because such lesions are often resected piecemeal owing to the technical limitations of standard EMR.
A new development in therapeutic endoscopy, called endoscopic submucosal dissection (ESD), allows the direct dissection of
the submucosa, and large lesions can be resected en bloc. ESD is not limited by resection size and is expected to replace
surgical resection. However, it is still associated with a higher incidence of complications than standard EMR procedures
and requires a high level of endoscopic skill. The endoscopic indications, techniques, and management of complications of
ESD for early gastric cancer for properly carrying out established therapeutic endoscopy are described. |
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Keywords: | endoscopic submucosal dissection (ESD) early gastric cancer complications histological staging |
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