[Endoscopic treatment of early gastric cancer: from Endoscopic Mucosal Resection (EMR) to Endoscopic Submucosal Dissection (ESD)]

Abstract

Surgery has been the traditional treatment for early gastric cancer, but it is known that the endoscopic treatment offers the same results with a lower mortality rate. The first endoscopic therapy used was the polypectomy in cases of pediculate tumors. However, in depressed or flat tumors, tissue-destructive methods are used together with sclerosant substances, laser or plasma argon; their disadvantage is that the procedure cannot be properly evaluated since the tissue is destroyed. On the other hand, the Endoscopic Mucous Resection (EMR) techniques, such as strip biopsy, the injecting and cutting technique, the transparent capsule or the varices ligation, does permit the evaluation of the results of the endoscopic treatment. Progresses in EMR are due to the use of the chromoscopy and the submucous injection of various substances (normal and hypertonic saline solution, hyaluronic acid, etc.). The problem of the EMR is local relapse, attributed to the resection in lesions fragments of more than 10 mm. To resolve this problem, the Endoscopic Submucous Dissection (ESD) has been developed, using the endoscopic scalpel or its modifications; such as the endoscopic scalpel with the isolated point (IT-Knife). The last ones require more operating time, better skills and have more complications. The efforts to make a better diagnosis and treatment of these lesions continue day by day, by using the magnification endoscopes, the endoscopes with multiple inflexions, etc.