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World J Gastrointest Endosc. Oct 16, 2012; 4(10): 438-447
Published online Oct 16, 2012. doi: 10.4253/wjge.v4.i10.438
Endoscopic submucosal dissection and surgical treatment for gastrointestinal cancer
Michio Asano
Michio Asano, Endoscopic Center, Colo-proctological Institute, Matsuda Hospital, Hamamatsu, Shizuoka 432-8061, Japan
Author contributions: Asano M was the sole contributor to this article.
Correspondence to: Michio Asano, MD, Endoscopic Center, Colo-proctological Institute, Matsuda Hospital, 753 Irino-cho, Nishi-ku, Hamamatsu, Shizuoka 432-8061, Japan. asano@matsuda-hp.or.jp
Telephone: +81-54-4485121 Fax: +81-54-4489753
Received: October 13, 2011
Revised: September 3, 2012
Accepted: October 13, 2012
Published online: October 16, 2012
Abstract

Endoscopic submucosal dissection (ESD) is widely used in Japan as a minimally invasive treatment for early gastric cancer. The application of ESD has expanded to the esophagus and colorectum. The indication criteria for endoscopic resection (ER) are established for each organ in Japan. Additional treatment, including surgery with lymph node dissection, is recommended when pathological examinations of resected specimens do not meet the criteria. Repeat ER for locally recurrent gastrointestinal tumors may be difficult because of submucosal fibrosis, and surgical resection is required in these cases. However, ESD enables complete resection in 82%-100% of locally recurrent tumors. Transanal endoscopic microsurgery (TEM) is a well-developed surgical procedure for the local excision of rectal tumors. ESD may be superior to TEM alone for superficial rectal tumors. Perforation is a major complication of ESD, and it is traditionally treated using salvage laparotomy. However, immediate endoscopic closure followed by adequate intensive treatment may avoid the need for surgical treatment for perforations that occur during ESD. A second primary tumor in the remnant stomach after gastrectomy or a tumor in the reconstructed organ after esophageal resection has traditionally required surgical treatment because of the technical difficulty of ER. However, ESD enables complete resection in 74%-92% of these lesions. Trials of a combination of ESD and laparoscopic surgery for the resection of gastric submucosal tumors or the performance of sentinel lymph node biopsy after ESD have been reported, but the latter procedure requires a careful evaluation of its clinical feasibility.

Keywords: Endoscopic submucosal dissection; Esophageal cancer; Gastric cancer; Colorectal cancer; Laparoscopic surgery; Lymph node metastasis; Perforation; Gastrectomy; Complications