title: Endoscopic resection of gastrointestinal lesions: advancement in the application of endoscopic submucosal dissection.
abstract: Curative endoscopic resection is now a viable option for a range of neoplastic lesions of the gastrointestinal tract (GIT) with low invasive potential. Risk of lymph node metastasis is the most important prognostic factor in selecting appropriate lesions for endoscopic therapy, and assessment of invasion depth is vital in this respect. To determine appropriate treatment, detailed endoscopic diagnosis and estimation of depth using magnifying chromoendoscopy is the gold standard in Japan. En bloc resection is the most desirable endoscopic therapy as risk of local recurrence is low and accurate histological diagnosis of invasion depth is possible. Endoscopic mucosal resection is established worldwide for the ablation of early neoplasms, but en bloc removal using this technique is limited to small lesions. Evidence suggests that a piecemeal resection technique has a higher local recurrence risk, therefore necessitating repeated surveillance endoscopy and further therapy. More advanced endoscopic techniques developed in Japan allow effective en bloc removal of early GIT neoplasms, regardless of size. This review discusses assessment of GIT lesions and options for endoscopic therapy with special reference to the introduction of endoscopic submucosal dissection into Western countries.
authors.affiliation: Department of Gastroenterology, Manchester Royal Infirmary, Manchester, UK.
authors.forename: Abby
authors.initials: A
authors.lastname: Conlin
authors.forename: Tonya
authors.initials: T
authors.lastname: Kaltenbach
authors.forename: Chika
authors.initials: C
authors.lastname: Kusano
authors.forename: Takahisa
authors.initials: T
authors.lastname: Matsuda
authors.forename: Ichiro
authors.initials: I
authors.lastname: Oda
authors.forename: Takuji
authors.initials: T
authors.lastname: Gotoda
mesh_terms: D004210:Dissection / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D005770:Gastrointestinal Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007089:Image Enhancement; D007564:Japan; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D013194:Staining and Labeling; D016896:Treatment Outcome; D019366:Western World