Abstract

EMURA, Fabián; ODA, Ichiro  and  ONO, Hiroyuki. Endoscopic Submucosal Dissection: A more effective procedure compared to mucosectomy for the treatment of Early Gastric Cancer. Rev Col Gastroenterol [online]. 2007, vol.22, n.3, pp.209-216. ISSN 0120-9957.

The new development in endoscopic techniques like endoscopic submucosal dissection (ESD) has revolutionized the minimally invasive treatment of gastric cancer. Different to conventional surgery, now it is possible treat large and ulcerative lesion with ESD and with low morbimortality. ESD constitutes a new development that allows direct visualization and cutting of the submucosal layer using el IT-Knife. Although mucosectomy is minimally invasive and safe, it is limited for the treatment of lesions >15 mm. Evidence suggests that if larger lesions are treated by this technique the resection will probably be a piecemeal resection due to limitations of standard mucosectomy. The largest series has reported 1033 ESD using the IT-knife in 945 patients. The en-block resection rate was 98% (1008/1033) and the rate en-block resection and negative margins was 93% (957/1033). In spite of these promising results, the complications rate is higher than that of standard mucosectomy since ESD needs high levels of endoscopic skills and experience. In addition evaluation of long term results is still ongoing. A detailed histological analysis along with adhesion to strict inclusion criteria are determinant for the reproducibility of success of DES in the west

Keywords : Early gastric cancer; Endoscopic submucosal dissection; IT-Knife; mucosectomy; curative resection.

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