Endoscopic submucosal dissection of early gastric cancer

Abstract

The purpose of this review was to examine a remarkable technical advance regarding the indications for and the technique of endoscopic resection of early gastric cancer. Endoscopic mucosal resection (EMR) of early gastric cancer with no risk of lymph node metastasis has been a standard technique in Japan, probably owing to the high incidence of gastric cancer in Japan and the fact that more than half of Japanese gastric cancer cases are diagnosed at an early stage. Very recently, several EMR techniques have become increasingly accepted and regularly used in Western countries. Although these minimally invasive techniques are safe, convenient, and efficacious, they are unsuitable for large lesions in particular. Difficulty in correctly assessing the depth of tumor invasion and an increase in local recurrence when standard EMR procedures are used have been reported in cases of large lesions, because such lesions are often resected piecemeal owing to the technical limitations of standard EMR. A new development in therapeutic endoscopy, called endoscopic submucosal dissection (ESD), allows the direct dissection of the submucosa, and large lesions can be resected en bloc. ESD is not limited by resection size and is expected to replace surgical resection. However, it is still associated with a higher incidence of complications than standard EMR procedures and requires a high level of endoscopic skill. The endoscopic indications, techniques, and management of complications of ESD for early gastric cancer for properly carrying out established therapeutic endoscopy are described.

Characterization of the Mucin Phenotype Can Predict Gastric Cancer Recurrence After Endoscopic Mucosal Resection

“…In the study conducted by Miyata et al (32) , a larger lesion size was associated with a higher number of resected fragments, showing a significant difference but no relation to lesion location. Other studies demonstrated a larger lesion size, a lower rate of en bloc resection, even with different techniques and similar local recurrence rates of 1.7% and 2.3%, respectively (11,58) . In this study, all 5 recurrences occurred with lesions smaller than 20 mm, while 3 of them were resected en bloc, so that local recurrence could not be attributed to these risk factors.…”

“…This is the rationale for local resection with endoscopic mucosal resection (EMR), or mucosectomy. The local recurrence rate after EMR for gastric adenocarcinoma ranges from 2% to 35% (11,59) . This is usually minimal for well-differentiated adenocarcinoma: en bloc resected, measuring up to 20 mm in size, restricted to the mucosa, and presenting without ulceration.…”

Long-Term Outcomes after D2 Gastrectomy for Early Gastric Cancer: Survival Analysis of a Single-Center Experience in China

“…Minimally invasive treatments, including endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD) and limited lymphadenectomy, are associated with surgical results that are no worse than those of conventional surgery (Ono et al, 2001). Endoscopic resection is widely performed as an alternative treatment to surgery in patients with mucosal tumors smaller than 20 mm that are of histologically differentiated types without ulceration, which are estimated to carry no risk of lymph node metastasis (Gotoda et al, 2006). In contrast to open procedures, EMR, ESD and limited lymphadenectomy have been performed in recent studies with nearly zero complications.…”

Relationship between socioeconomic status and accessibility for endoscopic resection among gastric cancer patients: using National Health Insurance Cohort in Korea: poverty and endoscopic resection

“…Endoscopic mucosal/submucosal resection (EMR) is an effective treatment method for gastric cancer patients. Using EMR, a drug is injected beneath the mucous membrane of a lesion through the endoscopic device, and the mucosa surrounding the lesion is grasped, lifted, strangulated, and resected by electrocautery [3]. Compared with laparotomy, EMR results in an easier recovery, less pain, and a smaller operation wound [4].…”