title: Endoscopic Submucosal Dissection for Early Gastric Cancer: Getting It Right!
abstract: Endoscopic resection is a widely accepted less-invasive treatment technique for local resection of early gastric cancer (EGC) lesions with a negligible risk of lymph node metastasis. Remarkable progress has been made during the last decade in this field, both in terms of expansion of the indications (to larger lesions and to lesions with ulceration) and in terms of technical improvements from endoscopic mucosal resection (EMR) to endoscopic submucosal dissection (ESD). Previously, larger lesions and lesions with ulceration were resected surgically because of the difficulty in effectively using EMR in this context. ESD however allows a high rate of en bloc resections, regardless of tumor location, tumor size, or the presence of ulceration. Nonetheless, ESD also has drawbacks: the procedure time is increased, ESD is more technically challenging compared to EMR, and, finally, ESD is associated with a slightly higher risk of complications. In order to overcome these limitations and minimize complications, a step-by-step process is important for learning ESD techniques. This chapter addresses the indications, results, some technical tips, and complications of ESD for EGC.
authors: Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. ioda@ncc.go.jp.
authors: Ichiro
authors: I
authors: Oda
authors: Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
authors: Harushisa
authors: H
authors: Suzuki
authors: Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
authors: Shigetaka
authors: S
authors: Yoshinaga
mesh_terms: D055088:Early Detection of Cancer; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects / Q000379:methods*; D005753:Gastric Mucosa / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D019106:Postoperative Hemorrhage / Q000209:etiology; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013272:Stomach Diseases / Q000209:etiology; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Bleeding; Early gastric cancer; Endoscopic mucosal resection; Endoscopic submucosal dissection; Perforation