Do we have enough evidence for expanding the indications of ESD for EGC

Endoscopic submucosal dissection（ESD） is the most advanced and representative technique in the field of therapeutic endoscopy and has been used for the treatment of gastrointestinal neoplasms,including early gastric cancer.The major difference and advantage of ESD compared to existing endoscopic res...

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Published inWorld journal of gastroenterology : WJG Vol. 17; no. 21; pp. 2597 - 2601
Main Authors Lee, Hang Lak, Choi, Chang Hwan, Cheung, Dae Young
Format Journal Article
LanguageEnglish
Published United States Baishideng Publishing Group Co., Limited 07.06.2011
Subjects
Aged
Dissection - methods
Endoscopy, Gastrointestinal - methods
Gastric Mucosa - pathology
Gastric Mucosa - surgery
Gastrointestinal Neoplasms - pathology
Gastrointestinal Neoplasms - surgery
Guidelines as Topic
Humans
Male
Republic of Korea
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
Topic Highlight
公共服务
切割设备
可持续发展教育
早期
电子化
胃癌
胃肠道肿瘤
证据
Republic of Korea
Endoscopic mucosal resection
Indications
Endoscopic submucosal dissection
Early gastric cancer
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Summary:Endoscopic submucosal dissection（ESD） is the most advanced and representative technique in the field of therapeutic endoscopy and has been used for the treatment of gastrointestinal neoplasms,including early gastric cancer.The major difference and advantage of ESD compared to existing endoscopic resection techniques,such as endoscopic mucosal resection（EMR） and polypectomy,are the width and depth of the resection.Newly developed cutting devices,distal attachable endoscopic accessories,and an advanced electrosurgical unit have helped to overcome the limitations of therapeutic endoscopy in terms of lesion size,location,presence of fibrotic scarring,and accompanying ulcers.As a result,the indications for ESD have been expanded from the classical indication for EMR and polypectomy,and there is now support for a further expansion of ESD indications.At present,the most critical factor to consider in the decision of whether to perform ESD is the probability of unexpected lymph node metastasis.The guidelines for ESD are continually being updated and debated.In this review,we discuss the strengths and weaknesses of the expanded guidelines,based on evidence found in the literature.
Bibliography:Hang Lak Lee,Chang Hwan Choi,Dae Young Cheung（Department of Internal Medicine,Hanyang University College of Medicine,Seoul 133-792,South Korea;2 Department of Internal Medicine,ChungAng University College of Medicine,Seoul 156-755,South Korea ,3.Division of Gastroenterology,Department of Internal Medicine,Yeouido St.Mary＇s Hospital,the Catholic University of Korea College of Medicine,Seoul 150-173,South Korea）
Endoscopic submucosal dissection; Endoscopic mucosal resection; Early gastric cancer; Indications
14-1219/R
Endoscopic submucosal dissection（ESD） is the most advanced and representative technique in the field of therapeutic endoscopy and has been used for the treatment of gastrointestinal neoplasms,including early gastric cancer.The major difference and advantage of ESD compared to existing endoscopic resection techniques,such as endoscopic mucosal resection（EMR） and polypectomy,are the width and depth of the resection.Newly developed cutting devices,distal attachable endoscopic accessories,and an advanced electrosurgical unit have helped to overcome the limitations of therapeutic endoscopy in terms of lesion size,location,presence of fibrotic scarring,and accompanying ulcers.As a result,the indications for ESD have been expanded from the classical indication for EMR and polypectomy,and there is now support for a further expansion of ESD indications.At present,the most critical factor to consider in the decision of whether to perform ESD is the probability of unexpected lymph node metastasis.The guidelines for ESD are continually being updated and debated.In this review,we discuss the strengths and weaknesses of the expanded guidelines,based on evidence found in the literature.
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Author contributions: Lee HL and Choi CH are contributed equally as a first author to this work; Lee HL and Choi CH contributed to the design frame work and wrote the paper; Cheung DY contributed to the appraisal of the literature and wrote the paper.
Telephone: +82-2-37791328 Fax: +82-2-37791331
Correspondence to: Dae Young Cheung, MD, Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, the Catholic University of Korea College of Medicine, Seoul 150-173, South Korea. adagio@catholic.ac.kr
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v17.i21.2597