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World J Gastroenterol. Jun 7, 2011; 17(21): 2597-2601
Published online Jun 7, 2011. doi: 10.3748/wjg.v17.i21.2597
Do we have enough evidence for expanding the indications of ESD for EGC?
Hang Lak Lee, Chang Hwan Choi, Dae Young Cheung
Hang Lak Lee, Department of Internal Medicine, Hanyang University College of Medicine, Seoul 133-792, South Korea
Chang Hwan Choi, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul 156-755, South Korea
Dae Young Cheung, 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
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.
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
Telephone: +82-2-37791328 Fax: +82-2-37791331
Received: June 25, 2010
Revised: September 20, 2010
Accepted: September 27, 2010
Published online: June 7, 2011
Abstract

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.

Keywords: Endoscopic submucosal dissection, Endoscopic mucosal resection, Early gastric cancer, Indications