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Indications, techniques, and outcomes of endoscopic submucosal dissection for esophageal squamous cell carcinoma

Esophagus volume 6, pages 143–148 (2009)Cite this article

Abstract

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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Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Mitsuhiro Fujishiro & Shinya Kodashima

Authors
  1. Mitsuhiro Fujishiro
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  2. Shinya Kodashima
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Correspondence to Mitsuhiro Fujishiro.

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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

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  • DOI: https://doi.org/10.1007/s10388-009-0195-y

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