Article

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: 2.37). 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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Available from: Kwang Bum Cho

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    ABSTRACT: Any prognosis of gastrointestinal (GI) cancer is closely related to the stage of the disease at diagnosis. Endoscopic submucosal dissection (ESD) and en bloc endoscopic mucosal resection (EMR) have been performed as curative treatments for many early-stage GI lesions in recent years. The technologies have been widely accepted in many Asian countries because they are minimally invasive and supply thorough histopathologic evaluation of the specimens. However, before engaging in endoscopic therapy, an accurate diagnosis is a precondition to effecting the complete cure of the underlying malignancy or carcinoma in situ. For the past few years, many new types of endoscopic techniques, including magnifying endoscopy with narrow-band imaging (ME-NBI), have emerged in many countries because these methods provide a strong indication of early lesions and are very useful in determining treatment options before ESD or EMR. However, to date, there is no comparable classification equivalent to "Kudo's Pit Pattern Classification in the colon", for the upper GI, there is still no clear internationally accepted classification system of magnifying endoscopy. Therefore, in order to help unify some viewpoints, here we will review the defining optical imaging characteristics and the current representative classifications of microvascular and microsurface patterns in the upper GI tract under ME-NBI, describe the accurate relationship between them and the pathological diagnosis, and their clinical applications prior to ESD or en bloc EMR. We will also discuss assessing the differentiation and depth of invasion, defying the lateral spread of involvement and targeting biopsy in real time.
    Preview · Article · Mar 2012 · World Journal of Gastroenterology
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    No preview · Article · Jan 2013 · Journal of Digestive Diseases
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