Endoscopic submucosal dissection (ESD) has gradually gained acceptance as one of the standard treatments for esophageal squamous cell carcinoma in Japan. Principal indications are little likelihood of nodal metastasis and having technical resectability. All lesions with preoperative diagnosis of high-grade intraepithelial neoplasms, including carcinomas in situ (T1a-EP), carcinomas invading the lamina propria (T1a-LPM), and some with preoperative diagnosis of carcinomas invading the muscularis mucosa (T1a-MM) and minute submucosal invasion (T1b-SM1), may become candidates for ESD, considering the substantial risks and benefits to be obtained. ESD as a staging measure to obtain histological confirmation of invasion depth and lymphovascular infiltration may be acceptable because preoperative prediction is difficult in some cases. In terms of technique, advantages of ESD in comparison with other endoscopic treatment are controllability in size and shape, and that even large and fibrotic neoplasms can be resected. Disadvantages may be longer procedure time, heavier bleeding, and greater possibility of perforation. However, with refinement of the technique, new devices, and the learning curve, acceptable technical safety has been achieved. Our experience with 104 consecutive cases shows favorable outcomes, although further innovation may be necessary. We are convinced that ESD will become a standard treatment for early-stage esophageal squamous cell carcinoma not only in Japan but also all over the world in the near future.
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Kakushima N, Fujishiro M. Endoscopic submucosal dissection for gastrointestinal neoplasms. World J Gastroenterol 2008;14:2362–2367.
Makuuchi H. Endoscopic mucosal resection for early esophageal cancer. Indication and techniques. Dig Endosc 1996;8:175–179.
Kodama M, Kakegawa T. Treatment of superficial cancer of the esophagus: a summary of responses to a questionnaire on superficial cancer of the esophagus in Japan. Surgery (St. Louis) 1998;123:432–439.
Shimizu Y, Tsukagoshi H, Fujita M, Hosokawa M, Kato M, Asaka M. Long-term outcome after endoscopic mucosal resection in patients with esophageal squamous cell carcinoma invading the muscularis mucosae or deeper. Gastrointest Endosc 2002;56:387–390.
Fujita H, Sueyoshi S, Yamana H, Shinozaki K, Toh U, Tanaka Y, et al. Optimum treatment strategy for superficial esophageal cancer: endoscopic mucosal resection versus radical esophagectomy. World J Surg 2001;25:424–431.
Kato H, Tachimori Y, Mizobuchi S, Igaki H, Ochiai A. Cervical, mediastinal, and abdominal lymph node dissection (three-field dissection) for superficial carcinoma of the thoracic esophagus. Cancer (Phila) 1993;72:2879–2882.
Kato H, Tachimori Y, Watanabe H, Yamaguchi H, Ishikawa T, Itabashi M. Superficial esophageal carcinoma. Surgical treatment and the results. Cancer (Phila) 1990;66:2319–2323.
Roth JA, Putnam JB Jr. Surgery for cancer of the esophagus. Semin Oncol 1994;21:453–461.
Oyama T, Tomori A, Hotta K, Morita S, Kominato K, Tanaka M, et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 2005;3:S67–S70.
Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, et al. Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol 2006;4:688–694.
Fujishiro M. Perspective on the practical indications of endoscopic submucosal dissection of gastrointestinal neoplasms. World J Gastroenterol 2008;14:4289–4295.
Wang GQ, Abnet CC, Shen Q, Lewin KJ, Sun XD, Roth MJ, et al. Histological precursors of oesophageal squamous cell carcinoma: results from a 13 year prospective follow up study in a high risk population. Gut 2005;54:187–192.
Shimizu Y, Kato M, Yamamoto J, Ono Y, Katsurada T, Ono S, et al. Histologic results of EMR for esophageal lesions diagnosed as high-grade intraepithelial squamous neoplasia by endoscopic biopsy. Gastrointest Endosc 2006;63:16–21.
Oyama T, Miyata Y, Shimatani S, Tomori A, Hotta K, Yoshida M. Lymph nodal metastasis of m3, sm1 esophageal cancer (in Japanese with English abstract). Stomach Intest (Tokyo) 2002;37:71–74.
Tajima Y, Nakanishi Y, Ochiai A, Tachimori Y, Kato H, Watanabe H, et al. Histopathologic findings predicting lymph node metastasis and prognosis of patients with superficial esophageal carcinoma: analysis of 240 surgically resected tumors. Cancer (Phila) 2000;88:1285–1293.
Ishihara R, Iishi H, Takeuchi Y, Kato M, Yamamoto S, Yamamoto S, et al. Local recurrence of large squamous-cell carcinoma of the esophagus after endoscopic resection. Gastrointest Endosc 2008;67:799–804.
Kuwano H, Nishimura Y, Ohtsu A, Kato H, Kitagawa Y, Tamai S, 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.
Ishihara R, Iishi H, Uedo N, Takeuchi Y, Yamamoto S, Yamada T, et al. Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan. Gastrointest Endosc 2008;68:1066–1072.
Saito Y, Takisawa H, Suzuki H, Takizawa K, Yokoi C, Nonaka S, et al. Endoscopic submucosal dissection of recurrent or residual superficial esophageal cancer after chemoradiotherapy. Gastrointest Endosc 2008;67:355–359.
Yoshida T, Inoue H, Usui S, Satodate H, Fukami N, Kudo S. Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions. Gastrointest Endosc 2004;59:288–295.
Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Ichinose M, Omata M. En bloc resection of a large semicircular esophageal cancer by endoscopic submucosal dissection. Surg Laparosc Endosc Percutan Tech 2006;16:237–241.
Fujishiro M, Kodashima S, Goto O, Ono S, Muraki Y, Kakushima N, et al. Successful en bloc resection of superficial esophageal cancer treated by endoscopic submucosal dissection with a splashneedle (with video). Endoscopy 2008;40:E81–E82.
Fujishiro M, Yahagi N, Kashimura K, Mizushima Y, Oka M, Enomoto S, et al. Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection. Endoscopy 2004;36:579–583.
Fujishiro M, Yahagi N, Kashimura K, Mizushima Y, Oka M, Enomoto S, et al. Different mixtures of sodium hyaluronate and their ability to create submucosal fluid cushions for endoscopic mucosal resection. Endoscopy 2004;36:584–589.
Fujishiro M, Yahagi N, Nakamura M, Kashimura K, Matsuura T, Kakushima N, et al. Tissue damage of different submucosal injection solutions for endoscopic mucosal resection. Gastrointest Endosc 2005;62:933–942.
Fujishiro M, Yahagi N, Nakamura M, Kakushima N, Kodashima S, Ono S, et al. Successful treatment outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar. Gastrointest Endosc 2006;63:243–249.
Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Tateishi A, et al. Management of bleeding concerning endoscopic submucosal dissection with the flex knife for stomach neoplasm. Dig Endosc 2006;18:S119–S122.
Takubo K, Aida J, Sawabe M, Kurosumi M, Arima M, Fujishiro M, et al. Early squamous cell carcinoma of the oesophagus: the Japanese viewpoint. Histopathology (Oxf) 2007;51:733–742.
Saito Y, Tanaka T, Andoh A, Minematsu H, Hata K, Tsujikawa T, et al. Novel biodegradable stents for benign esophageal strictures following endoscopic submucosal dissection. Dig Dis Sci 2008;53:330–333.
Ohki T, Yamato M, Murakami D, Takagi R, Yang J, Namiki H, et al. Treatment of oesophageal ulcerations using endoscopic transplantation of tissue-engineered autologous oral mucosal epithelial cell sheets in a canine model. Gut 2006;55:1704–1710.
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Fujishiro, M., Kodashima, S. Indications, techniques, and outcomes of endoscopic submucosal dissection for esophageal squamous cell carcinoma. Esophagus 6, 143–148 (2009). https://doi.org/10.1007/s10388-009-0195-y