Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2012;25(4):281-290.

Endoscopic management of early gastric cancer: endoscopic mucosal resection or endoscopic submucosal dissection: data from a Japanese high-volume center and literature review

Noriya Uedo  1 , Yoji Takeuchi  1 , Ryu Ishihara  1
Affiliations
Review

Endoscopic management of early gastric cancer: endoscopic mucosal resection or endoscopic submucosal dissection: data from a Japanese high-volume center and literature review

Noriya Uedo et al. Ann Gastroenterol. 2012.

Abstract

As detection of early gastric cancer (EGC) has improved, endoscopic mucosal resection (EMR) has been adopted as a treatment option for small intramucosal carcinoma. Endoscopic submucosal dissection (ESD) has enabled high en bloc resection rate for small and large lesions, as well as those with scarring. Moreover, the specimens obtained by ESD facilitate precise histological assessment of curability compared with the piecemeal specimens obtained by EMR. Accordingly, ESD has been established as a standard treatment for management of EGC in Japan. The long-term outcome of endoscopic management of EGC is based on: a) the accuracy of endoscopic diagnosis which defines the optimal treatment; b) endoscopist's expertise on methods for tumor removal (currently techniques of ESD); c) precise histological assessment of the resected specimen for curability; and d) surveillance endoscopy for early detection of metachronous multiple cancer. Efforts to establish a standardized protocol for practice and training can accelerate dissemination of gastric ESD in regions where gastric cancer is highly prevalent, and may help endoscopists worldwide to adopt this technique for other organs in the digestive tract.

Keywords: early gastric cancer; endoscopic mucosal resection; endoscopic submucosal dissection.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Method of strip biopsy endoscopic mucosal resection. (A) Injection of physiological saline; (B) grasping a lesion with forceps passed through a snare wire; (C) closing the snare; (D) cutting
Figure 2
Figure 2
Method of endoscopic submucosal dissection. (A-B) Marking under chromoendoscoy; (C) solution injection outside marking; (D) circumferential mucosal incision; (E) solution injection beneath the lesion; (F-G) submucosal dissection; (H) retrieval of resected specimen
Figure 3
Figure 3
Representative devices used for gastric endoscopic submucosal dissection. (A) Insulation-tipped diathermic knife-2; (B) ball-tipped flush knife; (C) hook knife; (D) hemostatic forceps (Coagrasper)
Figure 4
Figure 4
Flow of endoscopic management of early gastric cancer with endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD). It consists of pretreatment diagnosis, EMR/ESD procedure, histological assessment and endoscopic surveillance
Figure 5
Figure 5
Participant flow of outcome analysis in the Osaka Medical Center for Cancer and Cardiovascular Diseases EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection
Figure 6
Figure 6
En bloc resection rate of endoscopic mucosal resection and endoscopic submucosal dissection in our institution
Figure 7
Figure 7
Curable resection rate of endoscopic mucosal resection and endoscopic submucosal dissection in our institution
Figure 8
Figure 8
Delayed bleeding rate of endoscopic mucosal resection and endoscopic submucosal dissection in our institution
Figure 9
Figure 9
Perforation rate of endoscopic mucosal resection and endoscopic submucosal dissection in our institution
See this image and copyright information in PMC

References

    1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–2917. - PubMed
    1. Murakami T. Pathomorphological diagnosis. Definition and gross classification of early gastric cancer. Gann Monogr Cancer Res. 1971;11:53–55.
    1. Sano T, Kobori O, Muto T. Lymph node metastasis from early gastric cancer: endoscopic resection of tumour. Br J Surg. 1992;79:241–244. - PubMed
    1. Tsuji N, Ishiguro S, Suzuki N, et al. Risk factors for lymph node metastasis of intramucosal gastric cancer: a case-control study. Gastroenterol Endosc. 1999;41:1059–1065.
    1. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3) Gastric Cancer. 2011;14:113–123. - PubMed

LinkOut - more resources