Opinion statement
Endoscopic resection as curative treatment is feasible and indicated for gastrointestinal adenomas and early cancer limited to the mucosal layer and submucosal layers, where the risk for nodal and distant metastases is minimal. The initial technique of endoscopic resection, endoscopic mucosal resection, was limited by the inability to have en bloc resections for lesions larger than 2 cm. This meant that proper assessment of resection margins and depths was not possible in these cases, with the risk of incomplete resection and remnant lesions. In the last decade, the technique of endoscopic submucosal dissection was introduced, and this has allowed en bloc resection of superficial cancers of the esophagus, stomach, and colon. Cumulative data have shown high en bloc resection rates and excellent short-term and long-term outcomes when treatment inclusion criteria are adhered to. Endoscopic resection techniques were recently applied in the context of submucosal lesions. In the case of lesions located in the muscularis mucosa and submucosal layers, the gastrointestinal wall is not breached during endoscopic resection. However, in the case of submucosal lesion located in the muscularis propria layer, endoscopic mucosal resection or endoscopic submucosal dissection would result in perforation which may not be easily closed endoscopically. The technique of endoscopic submucosal tunneling was introduced in the context of peroral endoscopic myotomy for the treatment of achalasia. The principle was extended to the resection of tumors arising from the muscularis propria layer, with promising results.
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References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance
Soetikno RM, Gotoda T, Nakanishi Y, et al. Endoscopic mucosal resection. Gastrointest Endosc. 2003;57:567–79.
Yamamoto H. Endoscopic submucosal dissection--current success and future directions. Nat Rev Gastroenterol Hepatol. 2012;9:519–29. This review article provides an excellent summary of endoscopic submucosal dissection.
Abe N, Takeuchi H, Ooki A, et al. Recent developments in gastric endoscopic submucosal dissection: towards the era of endoscopic resection of layers deeper than the submucosa. Dig Endosc. 2013;25 Suppl 1:64–70.
Tajima Y, Nakanishi Y, Ochiai A, et al. Histopathologic findings predicting lymph node metastasis and prognosis of patients with superficial esophageal carcinoma: analysis of 240 surgically resected tumors. Cancer. 2000;88:1285–93.
Kuwano H, Nishinuma Y, Ohtsu A, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus. April 2007 edition: part I. Edited by the Japan Esophageal Society. Esophagus. 2008;5:61–73.
Holscher AH, Bollschweiler E, Schneider PM, et al. Early adenocarcinoma in Barrett’s oesophagus. Br J Surg. 1997;84:1470–3.
Stein HJ, Feith M, Mueller J, et al. Limited resection for early adenocarcinoma in Barrett’s esophagus. Ann Surg. 2000;232:733–42.
Feith M, Stein HJ, Siewert JR. Pattern of lymphatic spread of Barrett’s cancer. World J Surg. 2003;27:1052–7.
Seewald S, Ang TL, Soehendra N. Endoscopic mucosal resection of Barrett's oesophagus containing dysplasia or intramucosal cancer. Postgrad Med J. 2007;83:367–72.
Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–25.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010. Gastric Cancer. 2011;14:113–23.
Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:1977–81.
Zauber AG, Winawer SJ, O'Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366:687–96.
Watanabe T, Itabashi M, Shimada Y, et al. Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol. 2012;17:1–29.
Deyhle P, Largiadèr F, Jenny S. A method for endoscopic electroresection of sessile colonic polyps. Endoscopy. 1973;5:38–40.
Tada M, Shimada M, Murukami F, et al. Development of the strip-off biopsy [in Japanese with English abstract]. Gastroenterol Endosc. 1984;26:833–9.
Soehendra N, Binmoeller KF, Bohnacker S, et al. Endoscopic snare mucosectomy in the esophagus without any additional equipment: a simple technique for resection of flat early cancer. Endoscopy. 1997;29:380–3.
Inoue H, Takeshita K, Hori H, et al. Endoscopic mucosal resection with a cap fitted panendoscope for esophagus, stomach and colon mucosal lesions. Gastrointest Endosc. 1993;39:58–62.
Makuuchi H, Machimura T, Soh Y. Endoscopic mucosectomy for mucosal carcinomas in the esophagus. J Jpn Gastroenterol Surg. 1991;24:2599–603.
Chaves DM, Sakai P, Mester M, et al. A new endoscopic technique for the resection of flat polypoid lesions. Gastrointest Endosc. 1994;40:224–6.
Fleischer DE, Wang GQ, Dawsey S, et al. Tissue band ligation followed by snare resection (band and snare): a new technique for tissue acquisition in the esophagus. Gastrointest Endosc. 1996;44:68–72.
Soehendra N, Seewald S, Groth S, et al. Use of modified multiband ligator facilitates circumferential endoscopic mucosal resection in Barrett’s esophagus (+video). Gastrointest Endosc. 2006;63:847–52.
Gotoda T, Jung HY. Endoscopic resection (endoscopic mucosal resection/ endoscopic submucosal dissection) for early gastric cancer. Dig Endosc. 2013;25 Suppl 1:55–63.
Ono S, Fujishiro M, Koike K. Endoscopic submucosal dissection for superficial esophageal neoplasms. World J Gastrointest Endosc. 2012;4:162–6.
Tanaka S, Terasaki M, Kanao H, Shiro Oka S, Chayama K. Current status and future perspectives of endoscopic submucosal dissection for colorectal tumors. Dig Endosc. 2013;24 Suppl 1:73–9.
Ang TL, Khor CJ, Gotoda T. Diagnosis and endoscopic resection of early gastric cancer. Singapore Med J. 2010;51:93–100.
Yahagi N, Yamamoto H. Endoscopic submucosal dissection for colorectal lesions. Tech Gastrointest Endosc. 2013;15:96–100.
Cao Y, Liao C, Tan A, et al. Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy. 2009;41:751–7.
Takahashi H, Arimura Y, Masao H, et al. Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc. 2010;72:255–64.
Lian J, Chen S, Zhang Y, et al. A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc. 2012;76:763–70.
Tajika M, Niwa Y, Bhatia V, et al. Comparison of endoscopic submucosal dissection and endoscopic mucosal resection for large colorectal tumors. Eur J Gastroenterol Hepatol. 2011;23:1042–9.
Ono S, Fujishiro M, Niimi K, et al. Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc. 2009;70:860–6.
Koike T, Nakagawa K, Iijima K, et al. Endoscopic resection (endoscopic submucosal dissection/ endoscopic mucosal resection) for superficial Barrett's esophageal cancer. Dig Endosc. 2013;25 Suppl 1:20–8.
Pech O, May A, Manner H, et al. Long-Term Efficacy and Safety of Endoscopic Resection for Patients with Mucosal Adenocarcinoma of the Esophagus. Gastroenterology 2013 Nov 20. [Epub ahead of print]
Seewald S, Ang TL, Gotoda T, Soehendra N. Total endoscopic resection of Barrett esophagus. Endoscopy. 2008;40:1016–20.
Haidry RJ, Dunn JM, Butt MA, et al. Radiofrequency ablation and endoscopic mucosal resection for dysplastic Barrett's esophagus and early esophageal adenocarcinoma: outcomes of the UK National Halo RFA Registry. Gastroenterology. 2013;145:87–95.
Isomoto H, Shikuwa S, Yamaguchi N, et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut. 2009;58:331–6.
Ahn JY, Jung HY, Choi KD. e al. Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc. 2011;74:485–93.
Okada K, Fujisaki J, Yoshida T, et al. Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer. Endoscopy. 2012;44:122–7.
Abe S, Oda I, Suzuki H, et al. Short- and long-term outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Endoscopy. 2013;45:703–7.
Sekiguchi M, Suzuki H, Oda I, et al. Favorable long-term outcomes of endoscopic submucosal dissection for locally recurrent early gastric cancer after endoscopic resection. Endoscopy. 2013;45:708–13.
Repici A, Hassan C, De Paula PD, et al. Efficacy and safety of endoscopic submucosal dissection for colorectal neoplasia: a systematic review. Endoscopy. 2012;44:137–50.
Saito Y, Uraoka T, Yamaguchi Y, et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc. 2010;72:1217–25.
Lee EJ, Lee JB, Lee SH, et al. Endoscopic submucosal dissection for colorectal tumors–1,000 colorectal ESD cases: one specialized institute's experiences. Surg Endosc. 2013;27:31–9.
Moss A, Bourke MJ, Williams SJ, et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology. 1909–1918;2011:140.
Tanaka S, Terasaki M, Hayashi N, et al. Warning for unprincipled colorectal endoscopic submucosal dissection: accurate diagnosis and reasonable treatment strategy. Dig Endosc. 2013;25:107–16.
Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–71.
Inoue H, Ikeda H, Hosoya T, et al. Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia. Endoscopy. 2012;44:225–30.
Liu BR, Song JT, Kong LJ, et al. Tunneling endoscopic muscularis dissection for subepithelial tumors originating from the muscularis propria of the esophagus and gastric cardia. Surg Endosc. 2013;27:4354–9.
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Tiing Leong Ang declares that he have no conflict of interest.
Stefan Seewald declares that he have no conflict of interest.
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Ang, T.L., Seewald, S. Endoluminal Resection and Tissue Acquisition. Curr Treat Options Gastro 12, 140–153 (2014). https://doi.org/10.1007/s11938-014-0010-2
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DOI: https://doi.org/10.1007/s11938-014-0010-2