Endoscopic mucosal resection and endoscopic submucosal dissection for esophageal dysplasia and carcinoma

Advanced cancer in the esophagus is a serious and fatal disease that invades locally to deeper layers of the esophageal wall with significant risk of nodal metastasis and invasion of adjacent organs. One reliable method of avoiding this is to detect lesions at an early stage of esophageal cancer and then to resect them locally. A major advantage of endoscopic local resection is to recover a specimen for histopathologic analysis, which helps to make a clinical decision for further therapy. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have already been established as the techniques of endoscopic local resection. EMR includes strip-off biopsy, double-channel techniques, cap technique, EMR using a ligating device, and so on. ESD is a newly developed technique in which submucosal dissection is carried out using an electrocautery knife to acquire a single-piece specimen.