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Updated: Jul 6, 2026
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Evaluation of the Effectiveness of Longitudinal Incision for Endoscopic Submucosal Excavation of Gastric Subepithelial Lesions
Published on: April 28, 2026
Endoscopic submucosal dissection for gastric cancer
1Mitsuhiro Fujishiro, MD, PhD Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. mtfujish-kkr@umin.ac.jp.
Current Treatment Options in Gastroenterology
|March 7, 2008
Summary
Endoscopic submucosal dissection (ESD) offers en bloc resection for early gastric cancer. While effective, lymph node metastasis risk and procedure complexities require careful patient selection and consideration of gastrectomy.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Endoscopic Therapeutics
Background:
- Early-stage gastric cancer management requires precise resection techniques.
- Endoscopic submucosal dissection (ESD) is an advanced endoscopic treatment for en bloc tumor removal.
- Lymph node metastasis risk influences treatment decisions in early gastric cancer.
Purpose of the Study:
- To delineate the indications and comparative role of Endoscopic Submucosal Dissection (ESD) versus other gastric cancer treatments.
- To highlight the technical aspects and limitations of ESD in clinical practice.
- To guide the selection of appropriate therapeutic modalities for early gastric cancer.
Main Methods:
- Review of current endoscopic techniques for gastric cancer resection.
- Comparison of outcomes and indications for ESD and Endoscopic Mucosal Resection (EMR).
- Discussion of surgical gastrectomy as an alternative or adjuvant therapy.
Main Results:
- ESD enables en bloc resection of early gastric cancers, suitable for lesions with low lymph node metastasis probability.
- ESD indications extend to larger and ulcerative lesions unsuitable for EMR.
- Gastrectomy with lymphadenectomy is recommended for high lymph node metastasis risk or post-ESD treatment.
Conclusions:
- ESD is a valuable endoscopic option for specific early gastric cancers, with technique selection based on operator expertise.
- EMR is best suited for small, non-ulcerated, intramucosal, differentiated cancers.
- Careful consideration of lymph node status and lesion characteristics is crucial for optimal treatment selection, balancing endoscopic and surgical approaches.
