Worldwide experiences of endoscopic submucosal dissection: not just Eastern acrobatics.

Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-712, South Korea.
World Journal of Gastroenterology (Impact Factor: 2.43). 06/2011; 17(21):2611-7. DOI: 10.3748/wjg.v17.i21.2611
Source: PubMed

ABSTRACT The high incidence of gastric cancer has led to the initiation of cancer screening programs. As a result, the number of early gastric cancer cases has increased and consequentially, the cancer mortality rate has decreased. Moreover, the development of minimally invasive endoscopic treatment has been introduced for these early lesions. Endoscopic submucosal dissection (ESD) is now recognized as one of the preferred treatment modalities for premalignant gastrointestinal epithelial lesions and early gastric cancer without lymph node metastasis. We review the results of ESD including experiences in Japan and Korea, as well as western countries.

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    ABSTRACT: Gastric cancer remains one of the most common causes of cancer death. However the proportion of early gastric cancer (EGC) at diagnosis is increasing. Endoscopic treatment for EGC is actively performed worldwide in cases meeting specific criteria. Endoscopic mucosal resection can treat EGC with comparable results to surgery for selected cases. Endoscopic submucosal dissection (ESD) increases the en bloc and complete resection rates and reduces the local recurrence rate. ESD has been performed with expanded indication and is expected to be more widely used in the treatment of EGC through the technological advances in the near future. This review will describe the techniques, indications and outcomes of endoscopic treatment for EGC.
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    ABSTRACT: Endoscopic submucosal dissection (ESD) is now recognized as the preferred treatment modality for gastrointestinal epithelial lesions. A 21-month-old female was admitted with a giant hyperplastic polyp causing a gastric outlet obstruction. Successful ESD was performed with caution. The post-procedural course was uneventful without a bleeding episode. Although further study of the feasibility of ESD in early children is necessary, ESD could be applied to avoid laparotomy even in young children.
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    ABSTRACT: Endoscopic submucosal dissection (ESD) has important advantages over endoscopic mucosal resection (EMR) for early gastrointestinal neoplasia treatment, but its difficult learning curve and associated risks have constrained its wider expansion. ESD training includes a comprehensive study of ESD basics, attending live cases and performing initial interventions in animal models, ideally under expert supervision. Mentoring methods in Japan and other Asian countries are reviewed, with a special concern in the conditions recommended for trainees to engage in an ESD program and achieve competence. Animal training is usually based on the well-known porcine model. Ex vivo models for esophageal, gastric and rectal ESD are cheap and easy to set up, whereas in vivo training requires special settings and veterinarian support. Nevertheless, it is advisable to gain experience in the live pig, with conditions that are similar to humans, before moving on to real patients. Particular attention is focused on colorectal ESD (CR-ESD), one of the most difficult locations for this technique. Since most of the potential lesions for ESD in Western countries are located in the colon or rectum, excellence in training is of paramount importance for successful outcomes in CR-ESD in the West.
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