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Endoscopic Submucosal Dissection for Early Gastric Cancer: Getting It Right!

  • Ichiro OdaEmail author
  • Harushisa Suzuki
  • Shigetaka Yoshinaga
Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 908)

Abstract

Endoscopic resection is a widely accepted less-invasive treatment technique for local resection of early gastric cancer (EGC) lesions with a negligible risk of lymph node metastasis. Remarkable progress has been made during the last decade in this field, both in terms of expansion of the indications (to larger lesions and to lesions with ulceration) and in terms of technical improvements from endoscopic mucosal resection (EMR) to endoscopic submucosal dissection (ESD). Previously, larger lesions and lesions with ulceration were resected surgically because of the difficulty in effectively using EMR in this context. ESD however allows a high rate of en bloc resections, regardless of tumor location, tumor size, or the presence of ulceration. Nonetheless, ESD also has drawbacks: the procedure time is increased, ESD is more technically challenging compared to EMR, and, finally, ESD is associated with a slightly higher risk of complications. In order to overcome these limitations and minimize complications, a step-by-step process is important for learning ESD techniques. This chapter addresses the indications, results, some technical tips, and complications of ESD for EGC.

Keywords

Early gastric cancer Endoscopic mucosal resection Endoscopic submucosal dissection Bleeding Perforation 

Supplementary material

Video 15.1

Basic movements of the IT-type knife. The IT-type knife should be pulled from the far side to the near side to use the metallic blade for cutting purposes (MPG 7482 kb)

Video 15.2

Basic movements of the needle-type knife. The needle-type knife should be pulled from the near side to the far side to avoid perforation. Therefore, the initial incision is made at the near side and then the knife tip is slid from the near side to the far side (MPG 8650 kb)

Video 15.3

Movements of a surgical knife. A surgical knife must be pulled from the far side to the near side for cutting purposes; this corresponds to the use of the IT-type knife (MPG 2636 kb)

Video 15.4

Movements of an electrosurgical knife. The use of an electrosurgical knife corresponds to the use of a needle-type knife (MPG 6968 kb)

Video 15.5

Submucosal dissection using an IT-type knife. The submucosal dissection is started lengthwise from the far side to the near side, and then a depression is made at the near side; then dissection is performed widthwise by hooking the IT-type knife on the edge of the depression. Movement parallel to the gastric wall curvature is important to avoid perforation (MPG 19414 kb)

Video 15.6

Submucosal dissection using the needle-type knife. Submucosal dissection using the needle-type knife is performed from the near side to the far side (MPG 4914 kb)

Video 15.7

Management of bleeding during ESD. Minor oozing can be controlled by electrocautery using a cutting device. Electrocautery using hemostatic forceps is suitable for arterial bleeding (MPG 19860 kb)

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Ichiro Oda
    • 1
    Email author
  • Harushisa Suzuki
    • 1
  • Shigetaka Yoshinaga
    • 1
  1. 1.Endoscopy DivisionNational Cancer Center HospitalTokyoJapan

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