ESD for Stomach

Abstract

In the history of gastric cancer treatment, many of the cases with gastric cancer discovered in the 1970s were in the advanced stage. As represented by the Appleby operation, extended radical surgery with lymph node dissection was globally accepted as a mainstream approach to gastric cancer, even in early gastric cancer (EGC). With the widespread adoption of nationwide screening in Japan, and the advancement of endoscope technology in the 1980s, the number of patients diagnosed with early gastric cancer has increased. The major advantage of endoscopic resection is the ability to provide an accurate pathological staging without precluding future surgical therapy. After endoscopic resection, pathological assessment of depth of cancer invasion, degree of cancer differentiation and involvement of lymphatics or vessels allows the prediction of the risk of lymph node metastasis (LNM). The risk of LNM or distant metastasis is then weighted against the risk of surgery. Endoscopic mucosal resection (EMR) technique was devised in 1984 as an application of endoscopic snare polypectomy. Although EMR technique has the advantage of being relatively simple, it cannot be used to remove lesions en bloc in large lesions. Then, endoscopic submucosal dissection (ESD) was devised in the middle 90s in order to remove EGC en bloc and avoid local recurrence. .Because ESD has a higher risk of complications such as severe bleeding and perforation than EMR, it still requires high endoscopic skills. Therefore, in order to standardize gastric ESD procedures not only in Japan and Korea but also in other countries with a low incidence of gastric cancer, this chapter presents simple ESD using a clutch cutter as a non-chip method.