The international emergence of endoscopic submucosal dissection for early gastric cancer.

摘要

Every endoscopic procedure has a cognitive and a technical component. What makes endoscopic submuco-sal dissection (ESD) challenging is that it requires constant data interpretation and decision making (from detecting a dysplastic lesion to defining the margins for resection, selecting the right tools, identifying and avoiding exposed vessels, and then determining the right plane for submu-cosal dissection). ESD is also labor intensive and demands a high level of technical expertise. In this issue of Gastrointestinal Endoscopy, 2 significant challenges to performing gastric ESD are addressed: (1) how to accurately determine the depth of invasion (T stage) for an early gastric cancer (EGC) and (2) what factors can be used to predict the time required to complete a gastric ESD.