How to justify endoscopic submucosal dissection in the Western world.

摘要

In Japan, endoscopic treatment is considered the treatment of choice for early gastroesophageal neoplasia. In the 1970 s, the high incidence of gastric cancer in Japan led to the initiation of screening programs, initially with double contrast studies and later with endoscopic inspection. As a result, the number of gastric and esophageal cancers detected at an early stage increased dramatically, and the endoscopic treatment of these early lesions evolved as a logical consequence. Initially early gastric and esophageal cancers were treated with endoscopic mucosal resection (EMR) techniques, of which the cap-based techniques are the most widely accepted [1]. These techniques suffer from the limitation that only lesions of a relatively small size can be resected in one piece (i.e., en bloc resection). Lesions larger than 15-20 mm generally require resection iimultiple pieces (i.e., piecemeal resection) [1 -4]. After piecemeal resection, however, it is difficult to assess the radicality at the resection margins. The radicality at the vertical resection margin can usually be adequately assessed, but since it is generally impossible to reconstruct the lesion from the resected specimens, radicality at the lateral resection margins can be uncertain.