Advertisement

Current Treatment Options in Gastroenterology

, Volume 11, Issue 2, pp 119–124 | Cite as

Endoscopic submucosal dissection for gastric cancer

  • Mitsuhiro Fujishiro
Article

Opinion statement

Endoscopic submucosal dissection (ESD) is a novel endoscopic treatment that enables a clinician to resect an early-stage gastric cancer in en bloc fashion. ESD is indicated for those cancers in which there is a high probability of en bloc resection and low probability of lymph node metastasis. The latter may be the limiting factor at institutions skilled at ESD. Several ESD techniques are available with similar outcomes. Thus, selection depends on operator preference and expertise. Gastrectomy with lymphadenectomy should be applied initially to those early gastric cancers with high probability of positive lymph nodes or as an additional treatment after ESD. Endoscopic mucosal resection (EMR) should be reserved for small, nonulcerated, intramucosal, differentiated cancers. Disadvantages of ESD in comparison with EMR are longer operation times and higher incidences of intraoperative bleeding and perforation, but the indication for ESD includes larger and ulcerative lesions not amenable to EMR.

Keywords

Hyaluronic Acid Endoscopic Submucosal Dissection Early Gastric Cancer Endoscopic Resection Endoscopic Mucosal Resection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Tada M, Murakami A, Karita M, et al.: Endoscopic resection of early gastric cancer. Endoscopy 1993, 25:445–450.PubMedCrossRefGoogle Scholar
  2. 2.
    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.PubMedGoogle Scholar
  3. 3.
    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, 3:219–225.PubMedCrossRefGoogle Scholar
  4. 4.
    Hirao M, Masuda K, Asanuma T, et al.: Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine. Gastrointest Endosc 1988, 34:264–269.PubMedGoogle Scholar
  5. 5.
    Ono H, Kondo H, Gotoda T, et al.: Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001, 48:225–229.PubMedCrossRefGoogle Scholar
  6. 6.
    Oyama T, Kikuchi Y: Aggressive endoscopic mucosal resection in the upper GI tract-hook knife EMR method. Minim Invasive Ther Allied Technol 2002, 11:291–295.Google Scholar
  7. 7.
    Yahagi N, Fujishiro M, Kakushima N, et al.: Endoscopic submucosal dissection for early gastric cancer using the tip of an electro-surgical snare (thin type). Dig Endosc 2004, 16:34–38.CrossRefGoogle Scholar
  8. 8.
    Kodashima S, Fujishiro M, Yahagi N, et al.: Endoscopic submucosal dissection for gastric neoplasia: experience with the flex-knife. Acta Gastroenterol Belg 2006, 69:224–229.PubMedGoogle Scholar
  9. 9.
    Inoue H, Sato Y, Kazawa T, et al.: Endoscopic submucosal dissection-using a triangle-tipped knife [in Japanese]. Stomach Intestine 2004, 39:53–56.Google Scholar
  10. 10.
    Yamamoto H, Yube T, Isoda N, et al.: A novel method of endoscopic mucosal resection using sodium hyaluronate. Gastrointest Endosc 1999, 50:251–256.PubMedCrossRefGoogle Scholar
  11. 11.
    Fujishiro M, Yahagi N, Kashimura K, et al.: Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection. Endoscopy 2004, 36:579–583.PubMedCrossRefGoogle Scholar
  12. 12.
    Fujishiro M, Yahagi N, Kashimura K, et al.: Tissue damage of different submucosal injection solutions for EMR. Gastrointest Endosc 2005, 62:933–942.PubMedCrossRefGoogle Scholar
  13. 13.
    Fujishiro M, Yahagi N, Nakamura M, et al.: Successful treatment outcomes of a novel endoscopic resection for gastrointestinal tumors: endoscopic submucosal dissection using a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar. Gastrointest Endosc 2006, 63:243–249.PubMedCrossRefGoogle Scholar
  14. 14.
    Fujishiro M: Endoscopic submucosal dissection for stomach neoplasms. World J Gastroenterol 2006, 12:5108–5112.PubMedGoogle Scholar
  15. 15.
    Minami S, Gotoda T, Ono H, et al.: Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery (with video). Gastrointest Endosc 2006, 63:596–601.PubMedCrossRefGoogle Scholar
  16. 16.
    Kakushima N, Fujishiro M, Yahagi N, et al.: Helicobacter pylori status and the extent of gastric atrophy do not affect ulcer healing after endoscopic submucosal dissection. J Gastroenterol Hepatol 2006, 21:1586–1589.PubMedCrossRefGoogle Scholar
  17. 17.
    Uedo N, Takeuchi Y, Yamada T, et al.: Effect of a proton pump inhibitor or an H(2)-receptor antagonist on prevention of bleeding from ulcer after endoscopic submucosal dissection of early gastric cancer: a prospective randomized controlled trial. Am J Gastroenterol 2007, 102:1610–1616.PubMedCrossRefGoogle Scholar
  18. 18.
    Yamamoto H, Kawata H, Sunada K, et al.: Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate. Gastrointest Endosc 2002, 56:507–512.PubMedCrossRefGoogle Scholar
  19. 19.
    Yamamoto H, Kawata H, Sunada K, et al.: Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood. Endoscopy 2003, 35:690–694.PubMedCrossRefGoogle Scholar
  20. 20.
    Gotoda T: A large endoscopic resection by endoscopic submucosal dissection procedure for early gastric cancer. Clin Gastroenterol Hepatol 2005, 3:S71–S73.PubMedCrossRefGoogle Scholar
  21. 21.
    Oyama T, Tomori A, Hotta K, et al.: Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 2005, 3:S67–S70.PubMedCrossRefGoogle Scholar
  22. 22.
    Fujishiro M, Goto O, Kakushima N, et al.: Endoscopic submucosal dissection of stomach neoplasms after unsuccessful endoscopic resection. Dig Liver Dis 2007, 39:566–571.PubMedCrossRefGoogle Scholar
  23. 23.
    Shiraishi N, Yasuda K, Kitano S: Laparoscopic gastrectomy with lymph node dissection for gastric cancer. Gastric Cancer 2006, 9:167–176.PubMedCrossRefGoogle Scholar
  24. 24.
    Shimoyama S, Seto Y, Yasuda H, et al.: Concepts, rationale, and current outcomes of less invasive surgical strategies for early gastric cancer: data from a quarter-century of experience in a single institution. World J Surg 2005, 29:58–65.PubMedCrossRefGoogle Scholar
  25. 25.
    Hiki Y, Shimao J, Yamao Y, et al.: The concepts, procedures, and problems related in endoscopic laser therapy of early gastric cancer. A retrospective study on early gastric cancer. Surg Endosc 1989, 3:1–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Tajiri H, Oguro Y: Laser endoscopic treatment for upper gastrointestinal cancers. J Laparoendosc Surg 1991, 1:71–78.PubMedGoogle Scholar
  27. 27.
    Gossner L, Ell C: Photodynamic therapy of gastric cancer. Gastrointest Endosc Clin N Am 2000, 10:461–480.PubMedGoogle Scholar
  28. 28.
    Tabuse K, Katsumi M, Nagai Y, et al.: Microwave tissue coagulation applied clinically in endoscopic surgery. Endoscopy 1985, 17:139–144.PubMedGoogle Scholar
  29. 29.
    Sagawa T, Takayama T, Oku T, et al.: Argon plasma coagulation for successful treatment of early gastric cancer with intramucosal invasion. Gut 2003, 52:334–339.PubMedCrossRefGoogle Scholar
  30. 30.
    Kitamura T, Tanabe S, Koizumi W, et al.: Argon plasma coagulation for early gastric cancer: technique and outcome. Gastrointest Endosc 2006, 63:48–54.PubMedCrossRefGoogle Scholar
  31. 31.
    Ohta H, Takekoshi T, Takagi K, et al.: Intramural injection of anticancer emulsion by gastroendoscopy [in Japanese]. Gan To Kagaku Ryoho 1982, 9:1969–1975.PubMedGoogle Scholar
  32. 32.
    Otani T, Tatsuka T, Kanamaru K, Okuda S: Intramural injection of ethanol under direct vision for the treatment of protuberant lesions of the stomach. Gastroenterology 1975, 69:123–129.PubMedGoogle Scholar
  33. 33.
    Reshamwala PA, Darwin PE: Endoscopic management of early gastric cancer. Curr Opin Gastroenterol 2006, 22:541–545.PubMedCrossRefGoogle Scholar
  34. 34.
    Tanabe S, Koizumi W, Kokutou M, et al.: Usefulness of endoscopic aspiration mucosectomy as compared with strip biopsy for the treatment of gastric mucosal cancer. Gastrointest Endosc 1999, 50:819–822.PubMedCrossRefGoogle Scholar
  35. 35.
    Watanabe K, Ogata S, Kawazoe S, et al.: Clinical outcomes of EMR for gastric tumors: historical pilot evaluation between endoscopic submucosal dissection and conventional mucosal resection. Gastrointest Endosc 2006, 63:776–782.PubMedCrossRefGoogle Scholar
  36. 36.
    Oka S, Tanaka S, Kaneko I, et al.: Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 2006, 64:877–883.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of Gastroenterology, Graduate School of MedicineUniversity of TokyoTokyoJapan

Personalised recommendations