Endoscopic mucosal resection for early esophageal cancer

Abstract

In the United States and Europe, the focus of endoscopic treatment for esophageal cancer has been the palliative management of advanced cancers. In Japan, where cancers of the esophagus and stomach have a high prevalence, the focus has been the early detection of esophageal cancer and the development of endoscopic modalities to curatively treat cancer. Advances in the endoscopic and endosonographic diagnosis of early esophageal cancer have paralleled the development of endoscopic resectional techniques, collectively referred to as endoscopic mucosal resection (EMR). EMR has achieved a high level of sophistication in Japan, where endoscopists use double-lumen endoscopes, specia overtubes, and innovative accessories to achieve complete and safe excision of early esophageal cancer. In appropriately selected patients, EMR offers an attractive alternative to conventional surgical management. Interest for EMR techniques is growing in the United States and Europe as a result of increased awareness of early cancer and the potential for cure endoscopically.