Gastrointestinal Epithelial Neoplasms: Endoscopic Submucosal Dissection (Methodology)

Endoscopic resection can be theoretically applied to the localized neoplasms without lymph node metastases. However, presently the application is limited to small lesions. The reason is that the conventional endoscopic resection method, that is endoscopic mucosal resection (EMR) reported by Tada et al. (1993) and Inoue et al. (1993), has a limitation in the resected size. Endoscopie submucosal dissection (ESD) technique is a new endoscopic treatment using cutting devices, which removes the lesion by following three steps: injecting fluid into the submucosa to elevate the lesion from the muscle layer, precutting the surrounding mucosa of the lesion, and dissecting the connective tissue of the submucosa beneath the lesion. The major advantages of this technique in comparison with conventional EMR are: (1) the resected size and shape can be controlled, (2) en bloc resection is possible even in a large lesion, and (3) the lesions with ulcerative findings are also resectable. Using the ESD technique, we can resect a large or ulcerative gastrointestinal (GI) epithelial neoplasm endoscopically, which can lead to cure the target lesion without resection of the GI organ.