Journal of Gastroenterology

, Volume 41, Issue 10, pp 929–942 | Cite as

Endoscopic submucosal dissection of early gastric cancer

  • Takuji Gotoda
  • Hironori Yamamoto
  • Roy M. Soetikno


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.

Key words

endoscopic submucosal dissection (ESD) early gastric cancer complications histological staging 


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Copyright information

© Springer-Verlag Tokyo 2006

Authors and Affiliations

  • Takuji Gotoda
    • 1
  • Hironori Yamamoto
    • 2
  • Roy M. Soetikno
    • 3
  1. 1.Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
  2. 2.Department of Internal Medicine, Division of GastroenterologyJichi Medical UniversityShimotsukeJapan
  3. 3.Veterans Affairs Palo Alto Health Care System and Stanford University School of MedicinePalo AltoUSA

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