Management of endoscopic submucosal dissection complications

Abstract

Endoscopic submucosal dissection (ESD) is a new promising technique that allows endoscopic en bloc resection of premalignant and early malignant lesions in the gastrointestinal tract. In contrast to conventional endoscopic mucosal resection (EMR), lesions can be resected en bloc irrespective of their size. Clear advantages are an improvement in histopathological assessment of R0 resections and a lower risk of recurrence. Large series from Japan have shown significant improvement of en bloc resections after ESD compared with EMR in early gastric cancers [1], colonic lesions [2], and early esophageal neoplasms [3]. Guideline criteria for the resection of early gastric cancers in the pre-ESD era restricted the lesion size to 20 mm or less for conventional EMR [4]. New data on the risk of lymph node metastasis in early gastric cancer and the new ESD technique have allowed an extension of the resection criteria [5] [6]; for differentiated intramucosal cancers, the restriction on size could be lifted completely.