Standardized endoscopic submucosal tunnel dissection for management of early esophageal tumors (with video)

Abstract

Endoscopic submucosal dissection (ESD) was first developed to remove en bloc early gastric neoplasms. Later, this technique was proposed for the management of esophageal and colorectal superficial tumors, and currently ESD is performed routinely in Asia. ESD is indicated for esophageal cancer with no or minimal risk of lymph node metastasis. When the lesions are classified according to the depth of invasion as intraepithelial carcinoma (M1), restricted within the proper mucosal layer (M2), adjacent to or invading but not beyond the muscularis mucosa (M3), invading the submucosal (SM) layer to a depth of one third (SM1) or more than one third (SM2 and SM3) of the layer thickness, then the incidence of lymph node metastasis was reported to be 0%, 0% to 5.6%, 8% to 18%, 11% to 53%, and 30% to 54%, respectively. Therefore, under the 2002 Japan Esophageal Society guidelines for the treatment of esophageal cancer, the absolute indication for endoscopic resection is defined as M1-M2 esophageal cancer as well as two thirds or less extension of the circumference, whereas the relative indication is defined as M3-SM1 esophageal cancer with as much as three fourths or more mucosal defect after resection. ESD with complete resection can only be considered curative for M1-M2 esophageal squamous cell