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, 5 (4), 418-26

Endoscopic Submucosal Dissection of Early Gastric Cancer


Endoscopic Submucosal Dissection of Early Gastric Cancer

Ki Joo Kang et al. Gut Liver.


Gastric cancer is the most common cancer worldwide. The proportion of early gastric cancer (EGC) cases at diagnosis has increased because of the use of mass screening endoscopy in older adults. Endoscopic mucosal resection has become the standard treatment for EGC in cases with standard indications because of its low risk of lymph node metastasis. A new endoscopic method, endoscopic submucosal dissection, has recently become available. This method allows en bloc resection without limitation of the size of the lesion. The goal of this article is to review the history and methods of endoscopic treatment with EGC, the conventional and extended indications, the therapeutic outcomes, and the complication rates.

Keywords: Early gastric cancer; Endoscopic submucosal dissection.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.


Fig. 1
Fig. 1
Standard endoscopic mucosal dissection (EMR) techniques. (A) EMR after circumferential pre-cutting (EMR-P). (B) Cap-fitted endoscopy (EMR-C).
Fig. 2
Fig. 2
The endoscopic submucosal dissection (ESD) procedure. (A) On the anterior wall of the antrum, a 1.2-cm type IIa early gastric cancer is found. (B) Indigocarmine is sprayed along the extent of tumor to aid visualization. (C) Marking outside the lesion. (D) After injection of saline mixed with diluted epinephrine (1:100,000) and indigocarmine into the submucosal layer, circumferential mucosal pre-cutting is performed using a standard needle knife. (E) After dissection of the submucosal layer, a post-ESD induced ulcer is seen. (F) Fixation of the tissue specimen.
Fig. 3
Fig. 3
Different types of knives used for endoscopic submucosal dissection. (A) Insulation-tipped diathermic knife. (B) Hook knife. (C) Flex knife. (D) Dual knife.
Fig. 4
Fig. 4
Bleeding during the endoscopic submucosal dissection procedure. (A) Type IIb early gastric cancer on the high body. (B) Dissection of the submucosal layer. (C) Arterial bleeding from the submucosal layer.
Fig. 5
Fig. 5
Perforation during the endoscopic submucosal dissection (ESD) procedure. (A) Type IIb early gastric cancer on the lower body. (B) Ulcer after ESD procedure. (C, D) Frank perforation of the ulcer bed. (E) Endoscopic closure with clips. (F) Free air on the chest X-ray.

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