Skip to main content

Advertisement

SpringerLink
Log in

EMR/ESD: Techniques, Complications, and Evidence

  • Large Intestine (R Chokshi, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To discuss endoscopic resection techniques of early gastrointestinal malignancy. The review will focus on the indications and outcomes of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD).

Recent Findings

EMR is indicated for upper GI lesions less than 20 mm provided they can be easily lifted and have a low risk of submucosal invasion (SMI). ESD should be considered for esophageal and gastric lesions that are bulky, show intramucosal carcinoma, or have a risk of superficial submucosal invasion. With regard to colonic polyps, EMR is acceptable for the removal of large colonic polyps using a piecemeal technique. ESD can be reserved for rectal neuroendocrine tumors, fibrotic polyps, or polyps harboring early malignancy.

Summary

In selected cases, particularly in lesions less than 2 cm in size, EMR can be safe and effective. For larger lesions or lesions with submucosal invasion, ESD is effective and curative. Choosing the best approach can be tailored for each patient depending on lesion size, pathology, and availability of local expertise.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Draganov PV, Wang AY, Othman MO, Fukami N. AGA Institute clinical practice update: endoscopic submucosal dissection in the United States. Clin Gastroenterol Hepatol. 2019;17(1):16–25.e1 This reference summarizes ESD indications for the commonly performed procedures in the US.

  2. Hwang JH, et al. Endoscopic mucosal resection. Gastrointest Endosc. 2015;82(2):215–26.

    PubMed  Google Scholar 

  3. Jung YS, Park DI. Submucosal injection solutions for endoscopic 581 mucosal resection and endoscopic submucosal dissection of gastrointestinal neoplasms. Gastrointestinal Intervention. 2013;2(2):73–7

  4. Fujishiro M, Yahagi N, Kashimura K, Mizushima Y, Oka M, Matsuura T, et al. Different mixtures of sodium hyaluronate and their ability to create submucosal fluid cushions for endoscopic mucosal resection. Endoscopy. 2004;36(7):584–9.

    CAS  PubMed  Google Scholar 

  5. 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(7):579–83.

    CAS  PubMed  Google Scholar 

  6. Lee SH, Park JH, Park DH, Chung IK, Kim HS, Park SH, et al. Clinical efficacy of EMR with submucosal injection of a fibrinogen mixture: a prospective randomized trial. Gastrointest Endosc. 2006;64(5):691–6.

    PubMed  Google Scholar 

  7. Yamamoto H, Yahagi N, Oyama T, Gotoda T, Doi T, Hirasaki S, et al. Usefulness and safety of 0.4% sodium hyaluronate solution as a submucosal fluid "cushion" in endoscopic resection for gastric neoplasms: a prospective multicenter trial. Gastrointest Endosc. 2008;67(6):830–9.

    PubMed  Google Scholar 

  8. Fasoulas K, Lazaraki G, Chatzimavroudis G, Paroutoglou G, Katsinelos T, Dimou E, et al. Endoscopic mucosal resection of giant laterally spreading tumors with submucosal injection of hydroxyethyl starch: comparative study with normal saline solution. Surg Laparosc Endosc Percutan Tech. 2012;22(3):272–8.

    PubMed  Google Scholar 

  9. Feitoza AB, Gostout CJ, Burgart LJ, Burkert A, Herman LJ, Rajan E. Hydroxypropyl methylcellulose: a better submucosal fluid cushion for endoscopic mucosal resection. Gastrointest Endosc. 2003;57(1):41–7.

    PubMed  Google Scholar 

  10. Polymeros D, Kotsalidis G, Triantafyllou K, Karamanolis G, Panagiotides JG, Ladas SD. Comparative performance of novel solutions for submucosal injection in porcine stomachs: an ex vivo study. Dig Liver Dis. 2010;42(3):226–9.

    PubMed  Google Scholar 

  11. Conio M, Rajan E, Sorbi D, Norton I, Herman L, Filiberti R, et al. Comparative performance in the porcine esophagus of different solutions used for submucosal injection. Gastrointest Endosc. 2002;56(4):513–6.

    PubMed  Google Scholar 

  12. Kahler GF, et al. Selective tissue elevation by pressure injection (STEP) facilitates endoscopic mucosal resection (EMR). Surg Technol Int. 2007;16:107–12.

    PubMed  Google Scholar 

  13. Hirao M, et al. Endoscopic resection with local injection of hypertonic saline epinephrine for the treatment of early gastric cancer. Gan To Kagaku Ryoho. 1988;15(4 Pt 2–3):1466–72.

    CAS  PubMed  Google Scholar 

  14. Tanaka M, Ono H, Hasuike N, Takizawa K. Endoscopic submucosal dissection of early gastric cancer. Digestion. 2008;77(Suppl 1):23–8.

    PubMed  Google Scholar 

  15. Probst A, Maerkl B, Bittinger M, Messmann H. Gastric ischemia following endoscopic submucosal dissection of early gastric cancer. Gastric Cancer. 2010;13(1):58–61.

    PubMed  Google Scholar 

  16. Kim HH, et al. Myocardial infarction thought to be provoked by local epinephrine injection during endoscopic submucosal dissection. J Clin Med Res. 2011;3(3):143–6.

    PubMed  PubMed Central  Google Scholar 

  17. Poppers DM, Haber GB. Endoscopic mucosal resection of colonic lesions: current applications and future prospects. Med Clin North Am. 2008;92(3):687–705 x.

    PubMed  Google Scholar 

  18. Fleischer DE, Wang GQ, Dawsey S, Tio TL, Newsome J, Kidwell J, et al. Tissue band ligation followed by snare resection (band and snare): a new technique for tissue acquisition in the esophagus. Gastrointest Endosc. 1996;44(1):68–72.

    CAS  PubMed  Google Scholar 

  19. Binmoeller, K.F., et al., "Underwater" EMR without submucosal injection for large sessile colorectal polyps (with video). Gastrointest Endosc. 2012;75(5):1086–91.

  20. Arebi N, et al. Endoscopic mucosal resection of 161 cases of large sessile or flat colorectal polyps. 2007;42(7):859–66.

  21. Friedland S, et al. Endoscopic management of nonlifting colon polyps. 2013;2013.

  22. Luigiano, C., et al., Endoscopic mucosal resection for large and giant sessile and flat colorectal polyps: a single-center experience with long-term follow-up. Endoscopy. 2009;41(10):829–35.

  23. Thoguluva Chandrasekar V, et al. Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis. Gastrointest Endosc. 2019;89(5):929–936.e3.

    PubMed  Google Scholar 

  24. Thoguluva Chandrasekar V, et al. Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis. Gastrointest Endosc. 2019;89(5):929–936.e3.

    PubMed  Google Scholar 

  25. Burgess NG, Bourke MJ, Byth K. Prophylactic clip closure. Gastrointest Endosc. 2013;78(2):386–7.

    PubMed  Google Scholar 

  26. Shioji K, Suzuki Y, Kobayashi M, Nakamura A, Azumaya M, Takeuchi M, et al. Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy. Gastrointest Endosc. 2003;57(6):691–4.

    PubMed  Google Scholar 

  27. Zhang QS, Han B, Xu JH, Gao P, Shen YC. Clip closure of defect after endoscopic resection in patients with larger colorectal tumors decreased the adverse events. Gastrointest Endosc. 2015;82(5):904–9.

    PubMed  Google Scholar 

  28. Gotoda T, Kondo H, Ono H, Saito Y, Yamaguchi H, Saito D, et al. A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc. 1999;50(4):560–3.

    CAS  PubMed  Google Scholar 

  29. Jeon WJ, You IY, Chae HB, Park SM, Youn SJ. A new technique for gastric endoscopic submucosal dissection: peroral traction-assisted endoscopic submucosal dissection. Gastrointest Endosc. 2009;69(1):29–33.

    PubMed  Google Scholar 

  30. Oyama T. Counter traction makes endoscopic submucosal dissection easier. Clin Endosc. 2012;45(4):375–8.

    PubMed  PubMed Central  Google Scholar 

  31. Imaeda H, Iwao Y, Ogata H, Ichikawa H, Mori M, Hosoe N, et al. A new technique for endoscopic submucosal dissection for early gastric cancer using an external grasping forceps. Endoscopy. 2006;38(10):1007–10.

    CAS  PubMed  Google Scholar 

  32. Baldaque-Silva F, Vilas-Boas F, Velosa M, Macedo G. Endoscopic submucosal dissection of gastric lesions using the "yo-yo technique". Endoscopy. 2013;45(3):218–21.

    CAS  PubMed  Google Scholar 

  33. Matsumoto K, et al. A new traction device for facilitating endoscopic submucosal dissection (ESD) for early gastric cancer: the "medical ring". Endoscopy. 2011;43(Suppl 2 UCTN):E67–8.

    PubMed  Google Scholar 

  34. Parra-Blanco A, Nicolas D, Arnau MR, Gimeno-Garcia AZ, Rodrigo L, Quintero E. Gastric endoscopic submucosal dissection assisted by a new traction method: the clip-band technique. A feasibility study in a porcine model (with video). Gastrointest Endosc. 2011;74(5):1137–41.

    PubMed  Google Scholar 

  35. Fujii L, Onkendi EO, Bingener-Casey J, Levy MJ, Gostout CJ. Dual-scope endoscopic deep dissection of proximal gastric tumors (with video). Gastrointest Endosc. 2013;78(2):365–9.

    PubMed  Google Scholar 

  36. Monkemuller K, Wilcox CM. Interventional chromoendoscopy. Gastrointest Endosc. 2013;78(2):346–50.

    PubMed  Google Scholar 

  37. Wu J, Hu B. The role of carbon dioxide insufflation in colonoscopy: a systematic review and meta-analysis. Endoscopy. 2012;44(2):128–36.

    CAS  PubMed  Google Scholar 

  38. Maeda Y, et al. A pilot study to assess mediastinal emphysema after esophageal endoscopic submucosal dissection with carbon dioxide insufflation. Endoscopy. 2012;44(6):565–71.

    CAS  PubMed  Google Scholar 

  39. Yoshida N, Inoue K, Dohi O, Itoh Y. Precutting EMR with full or partial circumferential incision with a snare tip for the en-bloc resection of difficult colorectal lesions. VideoGIE. 2018;3(12):378–80.

    PubMed  PubMed Central  Google Scholar 

  40. Toyonaga T, Man-I M, Morita Y, Azuma T. Endoscopic submucosal dissection (ESD) versus simplified/hybrid ESD. Gastrointest Endosc Clin N Am. 2014;24(2):191–9.

    PubMed  Google Scholar 

  41. Wang, X.Y., et al., Efficacy and safety of hybrid endoscopic submucosal dissection compared with endoscopic submucosal dissection for rectal neuroendocrine tumors and risk factors associated with incomplete endoscopic resection. Ann Transl Med. 2020;8(6):368.

  42. Pimentel-Nunes P, et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2015;47(9):829–54.

    PubMed  Google Scholar 

  43. Saito I, Tsuji Y, Sakaguchi Y, Niimi K, Ono S, Kodashima S, et al. Complications related to gastric endoscopic submucosal dissection and their managements. Clinical endoscopy. 2014;47(5):398–403.

    PubMed  PubMed Central  Google Scholar 

  44. Yang D, Othman M, Draganov PV. Endoscopic Mucosal Resection vs Endoscopic Submucosal Dissection For Barrett’s Esophagus and Colorectal Neoplasia. Clin Gastroenterol Hepatol. 2019;17(6):1019–28.

    PubMed  Google Scholar 

  45. Odagiri H, Yasunaga H, Matsui H, Matsui S, Fushimi K, Kaise M. Hospital volume and adverse events following esophageal endoscopic submucosal dissection in Japan. Endoscopy. 2017;49(4):321–6.

    PubMed  Google Scholar 

  46. Murata A, Okamoto K, Muramatsu K, Matsuda S. Time trend of medical economic outcomes of endoscopic submucosal dissection for gastric cancer in Japan: a national database analysis. Gastric Cancer. 2014;17(2):294–301.

    PubMed  Google Scholar 

  47. Odagiri H, Yasunaga H, Matsui H, Fushimi K, Iizuka T, Kaise M. Hospital volume and the occurrence of bleeding and perforation after colorectal endoscopic submucosal dissection: analysis of a national administrative database in Japan. Dis Colon Rectum. 2015;58(6):597–603.

    PubMed  Google Scholar 

  48. Oda I. et al. Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive series. 2005;17(1):54–8.

    Google Scholar 

  49. Libanio D, et al. Risk factors for bleeding after gastric endoscopic submucosal dissection: a systematic review and meta-analysis. Gastrointest Endosc. 2016;84(4):572–86.

    PubMed  Google Scholar 

  50. Burgess NG, et al. Risk factors for intraprocedural and clinically significant delayed bleeding after wide-field endoscopic mucosal resection of large colonic lesions. Clin Gastroenterol Hepatol. 2014;12(4):651–61.e1–3.

    PubMed  Google Scholar 

  51. Nishizawa T, Suzuki H, Goto O, Ogata H, Kanai T, Yahagi N. Effect of prophylactic clipping in colorectal endoscopic resection: a meta-analysis of randomized controlled studies. United Eur Gastroenterol J. 2017;5(6):859–67.

    Google Scholar 

  52. Pohl H, et al. Clip Closure Prevents Bleeding After Endoscopic Resection of Large Colon Polyps in a Randomized Trial. Gastroenterology. 2019;157(4):977–984.e3.

    PubMed  Google Scholar 

  53. Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Tateishi A, Omata M. Management of bleeding concerning endoscopic submucosal dissection with the flex knife for stomach neoplasm. Dig Endosc. 2006;18:S119–S122.

  54. Aihara H, Kumar N, Ryou M, Abidi W, Ryan MB, Thompson CC. Facilitating endoscopic submucosal dissection: the suture-pulley method significantly improves procedure time and minimizes technical difficulty compared with conventional technique: an ex vivo study (with video). Gastrointest Endosc. 2014;80(3):495–502.

    PubMed  PubMed Central  Google Scholar 

  55. Kantsevoy SV, Wagner A, Mitrakov AA, Thuluvath AJ, Berr F. Rectal reconstruction after endoscopic submucosal dissection for removal of a giant rectal lesion. VideoGIE. 2019;4(4):179–81.

    PubMed  PubMed Central  Google Scholar 

  56. Kantsevoy SV, Bitner M, Hajiyeva G, Mirovski PM, Cox ME, Swope T, et al. Endoscopic management of colonic perforations: clips versus suturing closure (with videos). Gastrointest Endosc. 2016;84(3):487–93.

    PubMed  Google Scholar 

  57. Mannen K, Tsunada S, Hara M, Yamaguchi K, Sakata Y, Fujise T, et al. Risk factors for complications of endoscopic submucosal dissection in gastric tumors: analysis of 478 lesions. J Gastroenterol. 2010;45(1):30–6.

    PubMed  Google Scholar 

  58. Tsuji Y, Ohata K, Ito T, Chiba H, Ohya T, Gunji T, et al. Risk factors for bleeding after endoscopic submucosal dissection for gastric lesions. World J Gastroenterol. 2010;16(23):2913–7.

    PubMed  PubMed Central  Google Scholar 

  59. Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD study group multicenter study. Gastrointest Endosc. 2009;69(7):1228–35.

    PubMed  Google Scholar 

  60. Kataoka Y, Tsuji Y, Sakaguchi Y, Minatsuki C, Asada-Hirayama I, Niimi K, et al. Bleeding after endoscopic submucosal dissection: risk factors and preventive methods. World J Gastroenterol. 2016;22(26):5927–35.

    PubMed  PubMed Central  Google Scholar 

  61. Toyonaga T, Nishino E, Hirooka T, Ueda C, Noda K. Intraoperative bleeding in endoscopic submucosal dissection in the stomach and strategy for prevention and treatment. Digestive Endoscopy. 2006;18:S123–7. [Internet]. Wiley Online Library. Available from: https://doi.org/10.1111/j.1443-1661.2006.00645.x.

  62. Veekash G, Wei LX, Su M. Carbon dioxide pneumoperitoneum, physiologic changes and anesthetic concerns. Ambul Surg. 2010;16:41–6.

    Google Scholar 

  63. Fujishiro M, Yahagi N, Nakamura M, Kakushima N, Kodashima S, Ono S, et al. Successful 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(2):243–9.

    PubMed  Google Scholar 

  64. Nonaka, S., et al., Endoscopic submucosal dissection for early gastric cancer in the remnant stomach after gastrectomy. Gastrointest Endosc. 2013;78(1):63–72.

  65. Watari J, Tomita T, Toyoshima F, Sakurai J, Kondo T, Asano H, et al. Clinical outcomes and risk factors for perforation in gastric endoscopic submucosal dissection: a prospective pilot study. World J Gastrointest Endosc. 2013;5(6):281–7.

    PubMed  PubMed Central  Google Scholar 

  66. Li QL, Yao LQ, Zhou PH, Xu MD, Chen SY, Zhong YS, et al. Submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a large study of endoscopic submucosal dissection (with video). Gastrointest Endosc. 2012;75(6):1153–8.

    PubMed  Google Scholar 

  67. Park YM, Cho E, Kang HY, Kim JM. The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and metaanalysis. Surg Endosc. 2011;25(8):2666–77.

    PubMed  Google Scholar 

  68. Niimi K, Fujishiro M, Kodashima S, Goto O, Ono S, Hirano K, et al. Long-term outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy. 2010;42(9):723–9.

    CAS  PubMed  Google Scholar 

  69. • Saito Y, et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc. 2010;72(6):1217–25 One of the largest prospective studies discussing colonic ESD..

  70. Hayashi N, Tanaka S, Nishiyama S, Terasaki M, Nakadoi K, Oka S, et al. Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors. Gastrointest Endosc. 2014;79(3):427–35.

    PubMed  Google Scholar 

  71. Kiriyama S, Saito Y, Yamamoto S, Soetikno R, Matsuda T, Nakajima T, et al. Comparison of endoscopic submucosal dissection with laparoscopic-assisted colorectal surgery for early-stage colorectal cancer: a retrospective analysis. Endoscopy. 2012;44(11):1024–30.

    CAS  PubMed  Google Scholar 

  72. Tamegai Y, Saito Y, Masaki N, Hinohara C, Oshima T, Kogure E, et al. Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy. 2007;39(5):418–22.

    CAS  PubMed  Google Scholar 

  73. Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, et al. Successful nonsurgical management of perforation complicating endoscopic submucosal dissection of gastrointestinal epithelial neoplasms. Endoscopy. 2006;38(10):1001–6.

    CAS  PubMed  Google Scholar 

  74. Yoshida N, Wakabayashi N, Kanemasa K, Sumida Y, Hasegawa D, Inoue K, et al. Endoscopic submucosal dissection for colorectal tumors: technical difficulties and rate of perforation. Endoscopy. 2009;41(9):758–61.

    CAS  PubMed  Google Scholar 

  75. Lee EJ, Lee JB, Lee SH, Kim DS, Lee DH, Lee DS, et al. Endoscopic submucosal dissection for colorectal tumors--1,000 colorectal ESD cases: one specialized institute's experiences. Surg Endosc. 2013;27(1):31–9.

    PubMed  Google Scholar 

  76. Perez-Cuadrado-Robles E, et al. ESD versus EMR in non-ampullary superficial duodenal tumors: a systematic review and meta-analysis. Endosc Int Open. 2018;6(8):E998–E1007.

    PubMed  PubMed Central  Google Scholar 

  77. Takimoto K, Imai Y, Matsuyama K. Endoscopic tissue shielding method with polyglycolic acid sheets and fibrin glue to prevent delayed perforation after duodenal endoscopic submucosal dissection. Dig Endosc. 2014;26(Suppl 2):46–9.

    PubMed  Google Scholar 

  78. Kantsevoy SV, Bitner M, Mitrakov AA, Thuluvath PJ. Endoscopic suturing closure of large mucosal defects after endoscopic submucosal dissection is technically feasible, fast, and eliminates the need for hospitalization (with videos). Gastrointest Endosc. 2014;79(3):503–7.

    PubMed  Google Scholar 

  79. Ikezawa K, Michida T, Iwahashi K, Maeda K, Naito M, Ito T, et al. Delayed perforation occurring after endoscopic submucosal dissection for early gastric cancer. Gastric Cancer. 2012;15(1):111–4.

    PubMed  Google Scholar 

  80. Jung D, Youn YH, Jahng J, Kim JH, Park H. Risk of electrocoagulation syndrome after endoscopic submucosal dissection in the colon and rectum. Endoscopy. 2013;45(9):714–7.

    PubMed  Google Scholar 

  81. Lee TH, Hsueh PR, Yeh WC, Wang HP, Wang TH, Lin JT. Low frequency of bacteremia after endoscopic mucosal resection. Gastrointest Endosc. 2000;52(2):223–5.

    CAS  PubMed  Google Scholar 

  82. Watari J, Tomita T, Toyoshima F, Sakurai J, Kondo T, Asano H, et al. The incidence of "silent" free air and aspiration pneumonia detected by CT after gastric endoscopic submucosal dissection. Gastrointest Endosc. 2012;76(6):1116–23.

    PubMed  Google Scholar 

  83. Park CH, Kim H, Kang YA, Cho IR, Kim B, Heo SJ, et al. Risk factors and prognosis of pulmonary complications after endoscopic submucosal dissection for gastric neoplasia. Dig Dis Sci. 2013;58(2):540–6.

    PubMed  Google Scholar 

  84. Kusunoki, M., et al., The incidence of deep vein thrombosis in Japanese patients undergoing endoscopic submucosal dissection. Gastrointest Endosc, 2011;74(4):798–804.

  85. Dhakal P, Wang L, Gardiner J, Shrotriya S, Sharma M, Rayamajhi S. Effectiveness of sequential compression devices in prevention of venous thromboembolism in medically ill hospitalized patients: a retrospective cohort study. Turk J Haematol. 2019;36(3):193–8.

    PubMed  PubMed Central  Google Scholar 

  86. Yoshida M, Hanashi T, Momma K, Yamada Y, Sakaki N, Koike M, et al. Endoscopic mucosal resection for radical treatment of esophageal cancer. Gan To Kagaku Ryoho. 1995;22(7):847–54.

    CAS  PubMed  Google Scholar 

  87. Hashimoto S, Kobayashi M, Takeuchi M, Sato Y, Narisawa R, Aoyagi Y. The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest Endosc. 2011;74(6):1389–93.

    PubMed  Google Scholar 

  88. Sato H, Inoue H, Kobayashi Y, Maselli R, Santi EGR, Hayee B'H, et al. Control of severe strictures after circumferential endoscopic submucosal dissection for esophageal carcinoma: oral steroid therapy with balloon dilation or balloon dilation alone. Gastrointest Endosc. 2013;78(2):250–7.

    PubMed  Google Scholar 

  89. Abe S, Sakamoto T, Takamaru H, Yamada M, Nakajima T, Matsuda T, et al. Stenosis rates after endoscopic submucosal dissection of large rectal tumors involving greater than three quarters of the luminal circumference. Surg Endosc. 2016;30(12):5459–64.

    PubMed  Google Scholar 

  90. Singh S, et al. Incidence of esophageal adenocarcinoma in Barrett's esophagus with low-grade dysplasia: a systematic review and meta-analysis. Gastrointest Endosc. 2014;79(6):897–909.e4.

    PubMed  Google Scholar 

  91. Moss A, Bourke MJ, Hourigan LF, Gupta S, Williams SJ, Tran K, et al. Endoscopic resection for Barrett's high-grade dysplasia and early esophageal adenocarcinoma: an essential staging procedure with long-term therapeutic benefit. Am J Gastroenterol. 2010;105(6):1276–83.

    PubMed  Google Scholar 

  92. Ell C, May A, Pech O, Gossner L, Guenter E, Behrens A, et al. Curative endoscopic resection of early esophageal adenocarcinomas (Barrett's cancer). Gastrointest Endosc. 2007;65(1):3–10.

    PubMed  Google Scholar 

  93. Small AJ, et al. Comparative risk of recurrence of dysplasia and carcinoma after endoluminal eradication therapy of high-grade dysplasia versus intramucosal carcinoma in Barrett's esophagus. Gastrointest Endosc. 2015;81(5):1158–66.e1–4.

    PubMed  Google Scholar 

  94. Pech O, Behrens A, May A, Nachbar L, Gossner L, Rabenstein T, et al. Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut. 2008;57(9):1200–6.

    CAS  Google Scholar 

  95. Shaheen NJ, Falk GW, Iyer PG, Gerson LB. ACG clinical guideline: diagnosis and management of Barrett's esophagus. Am J Gastroenterol. 2016;111(1):30–50 quiz 51.

    CAS  PubMed  Google Scholar 

  96. Martelli MG, Duckworth LV, Draganov PV. Endoscopic submucosal dissection is superior to endoscopic mucosal resection for histologic evaluation of Barrett's esophagus and Barrett's-related neoplasia. Am J Gastroenterol. 2016;111(6):902–3.

    PubMed  Google Scholar 

  97. Desai M, et al. Efficacy and safety outcomes of multimodal endoscopic eradication therapy in Barrett’s esophagus-related neoplasia: a systematic review and pooled analysis. Gastrointest Endosc. 2017;85(3):482–495.e4.

    PubMed  Google Scholar 

  98. Fujiya M, Tanaka K, Dokoshi T, Tominaga M, Ueno N, Inaba Y, et al. Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc. 2015;81(3):583–95.

    PubMed  Google Scholar 

  99. 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(6):688–94.

    PubMed  Google Scholar 

  100. • Yang D, et al. Endoscopic submucosal dissection for early Barrett's neoplasia: a meta-analysis. Gastrointest Endosc. 2018;87(6):1383–93 This is the largest meta-analysis discussing the outcomes of ESD for esophageal adenocarcinoma.

  101. Guo HM, Zhang XQ, Chen M, Huang SL, Zou XP. Endoscopic submucosal dissection vs endoscopic mucosal resection for superficial esophageal cancer. World J Gastroenterol. 2014;20(18):5540–7.

    PubMed  PubMed Central  Google Scholar 

  102. Komeda Y, Bruno M, Koch A. EMR is not inferior to ESD for early Barrett's and EGJ neoplasia: an extensive review on outcome, recurrence and complication rates. Endosc Int Open. 2014;2(2):E58–64.

    PubMed  PubMed Central  Google Scholar 

  103. Terheggen G, Horn EM, Vieth M, Gabbert H, Enderle M, Neugebauer A, et al. A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett’s neoplasia. Gut. 2017;66(5):783–93.

    PubMed  Google Scholar 

  104. Yang D, Coman RM, Kahaleh M, Waxman I, Wang AY, Sethi A, et al. Endoscopic submucosal dissection for Barrett’s early neoplasia: a multicenter study in the United States. Gastrointest Endosc. 2017;86(4):600–7.

    PubMed  Google Scholar 

  105. Coman RM, Gotoda T, Forsmark CE, Draganov PV. Prospective evaluation of the clinical utility of endoscopic submucosal dissection (ESD) in patients with Barrett's esophagus: a western center experience. Endosc Int Open. 2016;4(6):E715–21.

    PubMed  PubMed Central  Google Scholar 

  106. Zauber AG, Winawer SJ, O'Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366(8):687–96.

    CAS  PubMed  PubMed Central  Google Scholar 

  107. Jayanna M, et al. Cost Analysis of Endoscopic Mucosal Resection vs Surgery for Large Laterally Spreading Colorectal Lesions. Clin Gastroenterol Hepatol. 2016;14(2):271–8.e1–2.

    PubMed  Google Scholar 

  108. Ahlenstiel G, Hourigan LF, Brown G, Zanati S, Williams SJ, Singh R, et al. Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon. Gastrointest Endosc. 2014;80(4):668–76.

    PubMed  Google Scholar 

  109. Ahlenstiel G, Hourigan LF, Brown G, Zanati S, Williams SJ, Singh R, et al. Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon. Gastrointest Endosc. 2014;80(4):668–76.

    PubMed  Google Scholar 

  110. Maehata, T., Kato, M., Ochiai, Y. et al. Feasibility of endoscopic submucosal dissection for colorectal neoplasia at anastomotic sites: a retrospective study. Surg Endosc. 2020.

  111. Moss A, Williams SJ, Hourigan LF, Brown G, Tam W, Singh R, et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian colonic EMR (ACE) study. Gut. 2015;64(1):57–65.

    PubMed  Google Scholar 

  112. Oka S, Tanaka S, Saito Y, Iishi H, Kudo SE, Ikematsu H, et al. Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol. 2015;110(5):697–707.

    PubMed  Google Scholar 

  113. Knabe M, Pohl J, Gerges C, Ell C, Neuhaus H, Schumacher B. Standardized long-term follow-up after endoscopic resection of large, nonpedunculated colorectal lesions: a prospective two-center study. Am J Gastroenterol. 2014;109(2):183–9.

    PubMed  Google Scholar 

  114. Holmes I, Kim HG, Yang DH, Friedland S. Avulsion is superior to argon plasma coagulation for treatment of visible residual neoplasia during EMR of colorectal polyps (with videos). Gastrointest Endosc. 2016;84(5):822–9.

    PubMed  Google Scholar 

  115. Tanaka S, Kashida H, Saito Y, Yahagi N, Yamano H, Saito S, et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2015;27(4):417–34.

    PubMed  Google Scholar 

  116. Benson AB 3rd, et al. Colon cancer, version 1.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2017;15(3):370–98.

    CAS  Google Scholar 

  117. De Ceglie A, et al. Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: a systematic review. Crit Rev Oncol Hematol. 2016;104:138–55.

    PubMed  Google Scholar 

  118. Burgess NG, et al. Risk Stratification for Covert Invasive Cancer Among Patients Referred for Colonic Endoscopic Mucosal Resection: A Large Multicenter Cohort. Gastroenterology. 2017;153(3):732–742.e1.

    PubMed  Google Scholar 

  119. Moss A, Bourke MJ, Williams SJ, Hourigan LF, Brown G, Tam W, et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology. 2011;140(7):1909–18.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Baylor St Luke’s Medical Center, Houston, TX, USA

    Yahya Ahmed & Mohamed Othman

  2. Division of Gastroenterology, Baylor College of Medicine, 7200 Cambridge St., 8th Floor, Suite 8B, Houston, TX, 77030, USA

    Mohamed Othman

Authors
  1. Yahya Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohamed Othman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohamed Othman.

Ethics declarations

Conflict of Interest

Mohamed Othman MD, is a consultant for Olympus, Boston Scientific, Conmed, Abbvie, and Lumendi.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Large Intestine

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ahmed, Y., Othman, M. EMR/ESD: Techniques, Complications, and Evidence. Curr Gastroenterol Rep 22, 39 (2020). https://doi.org/10.1007/s11894-020-00777-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11894-020-00777-z

Keywords

Search

Navigation