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Endoscopic submucosal dissection—current success and future directions

Nature Reviews Gastroenterology & Hepatology volume 9, pages 519–529 (2012)Cite this article

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Abstract

More than 10 years have passed since endoscopic submucosal dissection (ESD) was first developed in Japan. ESD enables en bloc complete resection of superficial gastrointestinal neoplasms regardless of the size and location of the lesions. With improvements in techniques and devices, excellent therapeutic results have been achieved despite the inherent technical difficulties of this procedure. ESD aiming for curative treatment can be performed for gastrointestinal neoplasms without risk of lymph node metastasis. Accurate histopathologic examination of the resected specimen is required to determine the risk of lymph node metastasis, for which en bloc resection is beneficial. Owing to the high success rate of en bloc complete resection and accurate histopathologic examination, tumour recurrence rates after ESD are reported to be very low in Japan. Excellent results of ESD in a large number of cases have also been reported from other Asian countries such as South Korea, Taiwan and China. Although scepticism exists among Western clinicians regarding the application of ESD, it is developing slowly and reports indicate promising results in some European countries. With further development of technologies, such as endoscopic robotics, ESD could become the worldwide treatment of choice for early gastrointestinal neoplasms.

Key Points

  • Endoscopic submucosal dissection (ESD) was developed in Japan to enable en bloc complete resection of superficial gastrointestinal neoplasms regardless of the size and location of the lesions

  • High levels of endoscopic and histopathologic diagnosis are required to determine the indication and curativeness of ESD

  • Oesophageal and gastric ESD are recognized as established therapeutic procedures in Japan

  • Colorectal ESD (which is technically more difficult than oesophageal and gastric ESD) is also becoming popular in Japan, with satisfactory therapeutic results

  • ESD is developing slowly in European countries, which suggests that ESD is a promising method for treating large superficial gastrointestinal tumours in worldwide settings

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Figure 1: Endoscopic submucosal dissection of a gastric lesion.
Figure 2: Macroscopic view of the resected specimen from Figure 1.
Figure 3: Knives used in endoscopic submucosal dissection.
Figure 4: Submucosal dissection with the SafeKnife V.
Figure 5: Scissor-type devices for endoscopic submucosal dissection.
Figure 6: Hoods used during endoscopic submucosal dissection.
Figure 7: Double-balloon endoscopy.

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References

  1. Inoue, H. et al. Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest. Endosc. 39, 58–62 (1993).

    Article  CAS  PubMed  Google Scholar 

  2. Karita, M., Tada, M. & Okita, K. The successive strip biopsy partial resection technique for large early gastric and colon cancers. Gastrointest. Endosc. 38, 174–178 (1992).

    Article  CAS  PubMed  Google Scholar 

  3. Takekoshi, T. et al. Endoscopic resection of early gastric carcinoma: results of a retrospective analysis of 308 cases. Endoscopy 26, 352–358 (1994).

    Article  CAS  PubMed  Google Scholar 

  4. Yamamoto, H. et al. Successful en bloc resection of a large superficial gastric cancer by using sodium hyaluronate and electrocautery incision forceps. Gastrointest. Endosc. 54, 629–632 (2001).

    Article  CAS  PubMed  Google Scholar 

  5. Ono, H. Early gastric cancer: diagnosis, pathology, treatment techniques and treatment outcomes. Eur. J. Gastroenterol. Hepatol. 18, 863–866 (2006).

    Article  PubMed  Google Scholar 

  6. Oyama, T. et al. Endoscopic submucosal dissection of early esophageal cancer. Clin. Gastroenterol. Hepatol. 3 (7 Suppl. 1), S67–S70 (2005).

    Article  PubMed  Google Scholar 

  7. Yamamoto, H., Yahagi, N. & Oyama, T. Mucosectomy in the colon with endoscopic submucosal dissection. Endoscopy 37, 764–768 (2005).

    Article  CAS  PubMed  Google Scholar 

  8. Ono, H. Endoscopic submucosal dissection for early gastric cancer. Chin. J. Dig. Dis. 6, 119–121 (2005).

    Article  PubMed  Google Scholar 

  9. Wehrmann, M., Greschniok, A., Offenhaeuser, S. & Bueltmann, B. Staging, grading and related histopathological techniques in local therapy of rectal tumours. Endosc. Surg. Allied Technol. 2, 237–240 (1994).

    CAS  PubMed  Google Scholar 

  10. Gotoda, T. et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3, 219–225 (2000).

    Article  PubMed  Google Scholar 

  11. Yamamoto, H. et al. Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate. Gastrointest. Endosc. 56, 507–512 (2002).

    Article  PubMed  Google Scholar 

  12. Bemelman, W. A. Minimally invasive surgery for early lower GI cancer. Best Pract. Res. Clin. Gastroenterol. 19, 993–1005 (2005).

    Article  CAS  PubMed  Google Scholar 

  13. Chen, W. T. et al. Single-incision laparoscopic versus conventional laparoscopic right hemicolectomy: a comparison of short-term surgical results. Surg. Endosc. 25, 1887–1892 (2011).

    Article  PubMed  Google Scholar 

  14. Kiyotoki, S. et al. Usefulness of magnifying endoscopy with narrow-band imaging for determining gastric tumor margin. J. Gastroenterol. Hepatol. 25, 1636–1641 (2010).

    Article  PubMed  Google Scholar 

  15. Osawa, H. et al. Optimal band imaging system can facilitate detection of changes in depressed-type early gastric cancer. Gastrointest. Endosc. 67, 226–234 (2008).

    Article  PubMed  Google Scholar 

  16. Yamamoto, H. Technology insight: endoscopic submucosal dissection of gastrointestinal neoplasms. Nat. Clin. Pract. Gastroenterol. Hepatol. 4, 511–520 (2007).

    Article  PubMed  Google Scholar 

  17. Shimoyama, S. et al. The useful combination of a higher frequency miniprobe and endoscopic submucosal dissection for the treatment of T1 esophageal cancer. Surg. Endosc. 20, 434–438 (2006).

    Article  CAS  PubMed  Google Scholar 

  18. Ichikawa, T., Kudo, M., Matsui, S., Okada, M. & Kitano, M. Endoscopic ultrasonography with three miniature probes of different frequency is an accurate diagnostic tool for endoscopic submucosal dissection. Hepatogastroenterology 54, 325–328 (2007).

    PubMed  Google Scholar 

  19. Okada, K. et al. Endoscopic ultrasonography is valuable for identifying early gastric cancers meeting expanded-indication criteria for endoscopic submucosal dissection. Surg. Endosc. 25, 841–848 (2011).

    Article  PubMed  Google Scholar 

  20. Eguchi, T. et al. Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases. Mod. Pathol. 19, 475–480 (2006).

    Article  PubMed  Google Scholar 

  21. Endo, M., Yoshino, K., Kawano, T., Nagai, K. & Inoue, H. Clinicopathologic analysis of lymph node metastasis in surgically resected superficial cancer of the thoracic esophagus. Dis. Esophagus 13, 125–129 (2000).

    Article  CAS  PubMed  Google Scholar 

  22. Kuwano, H. et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus. April 207 edition: part I edited by the Japan Esophageal Society. Esophagus 5, 61–73 (2008).

    Article  Google Scholar 

  23. Zemler, B., May, A., Ell, C. & Stolte, M. Early Barrett's carcinoma: the depth of infiltration of the tumour correlates with the degree of differentiation, the incidence of lymphatic vessel and venous invasion. Virchows Arch. 456, 609–614 (2010).

    Article  PubMed  Google Scholar 

  24. Pech, O., May, A., Gossner, L. & Ell, C. Barrett's esophagus: endoscopic resection. Gastrointest. Endosc. Clin. N. Am. 13, 505–512 (2003).

    Article  PubMed  Google Scholar 

  25. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14, 101–112 (2011).

  26. Okabe, S. et al. Lymph node metastasis in T1 adenocarcinoma of the colon and rectum. J. Gastrointest. Surg. 8, 1032–1039 (2004).

    Google Scholar 

  27. Kitajima, K. et al. Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J. Gastroenterol. 39, 534–543 (2004).

    Article  PubMed  Google Scholar 

  28. Saito, Y. et al. Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg. Endosc. 24, 343–352 (2010).

    Article  PubMed  Google Scholar 

  29. Watanabe, T. et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int. J. Clin. Oncol. 17, 1–29 (2012).

    Article  PubMed  Google Scholar 

  30. Hase, K. et al. Long-term results of curative resection of “minimally invasive” colorectal cancer. Dis. Colon Rectum 38, 19–26 (1995).

    Article  CAS  PubMed  Google Scholar 

  31. Egashira, Y. et al. Analysis of pathological risk factors for lymph node metastasis of submucosal invasive colon cancer. Mod. Pathol. 17, 503–511 (2004).

    Article  CAS  PubMed  Google Scholar 

  32. Yamamoto, H. et al. Usefulness and safety of 0.4% sodium hyaluronate solution as a submucosal fluid “cushion” in endoscopic resection for gastric neoplasms: a prospective multicenter trial. Gastrointest. Endosc. 67, 830–839 (2007).

    Article  PubMed  Google Scholar 

  33. Fujishiro, M. et al. Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection. Endoscopy 36, 579–583 (2004).

    Article  CAS  PubMed  Google Scholar 

  34. Yamamoto, H. et al. A novel method of endoscopic mucosal resection using sodium hyaluronate. Gastrointest. Endosc. 50, 251–256 (1999).

    Article  CAS  PubMed  Google Scholar 

  35. Yamamoto, H. et al. A successful single-step endoscopic resection of a 40 millimeter flat-elevated tumor in the rectum: endoscopic mucosal resection using sodium hyaluronate. Gastrointest. Endosc. 50, 701–704 (1999).

    Article  CAS  PubMed  Google Scholar 

  36. Yamamoto, H. et al. Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood. Endoscopy 35, 690–694 (2003).

    Article  CAS  PubMed  Google Scholar 

  37. Kodashima, S. et al. Endoscopic submucosal dissection for gastric neoplasia: experience with the flex-knife. Acta Gastroenterol. Belg. 69, 224–229 (2006).

    CAS  PubMed  Google Scholar 

  38. Toyanaga, T. et al. The results and limitations of endoscopic submucosal dissection for colorectal tumours. Acta Chir. Iugosl. 55, 17–23 (2008).

    Article  CAS  PubMed  Google Scholar 

  39. Toyonaga, T. et al. The performance of a novel ball-tipped Flush knife for endoscopic submucosal dissection: a case–control study. Aliment. Pharmacol. Ther. 32, 908–915 (2010).

    Article  CAS  PubMed  Google Scholar 

  40. Fernandez-Esparrach, G. et al. A novel device for endoscopic submucosal dissection that combines water-jet submucosal hydrodissection and elevation with electrocautery: initial experience in a porcine model. Gastrointest. Endosc. 71, 615–618 (2010).

    Article  PubMed  Google Scholar 

  41. Honma, K. et al. Endoscopic submucosal dissection for colorectal neoplasia. Dig. Endosc. 22, 307–311 (2010).

    Article  PubMed  Google Scholar 

  42. Akahoshi, K. et al. Endoscopic submucosal dissection using a grasping-type scissors forceps for early gastric cancers and adenomas. Dig. Endosc. 23, 24–29 (2011).

    Article  PubMed  Google Scholar 

  43. Muraki, Y. et al. Management of bleeding and artificial gastric ulcers associated with endoscopic submucosal dissection. World J. Gastrointest. Endosc. 4, 1–8 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  44. Enomoto, S. et al. Novel endoscopic hemostasis technique for use during endoscopic submucosal dissection. Endoscopy 39 (Suppl. 1), E156 (2007).

    Article  PubMed  Google Scholar 

  45. Kataoka, M. et al. Clinical evaluation of emergency endoscopic hemostasis with bipolar forceps in non-variceal upper gastrointestinal bleeding. Dig. Endosc. 22, 151–155 (2010).

    Article  PubMed  Google Scholar 

  46. Ishii, N. et al. Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife for superficial esophageal neoplasia. Is it safe for elderly patients? Surg. Endosc. 24, 2110–2119 (2010).

    Article  PubMed  Google Scholar 

  47. Ishii, N. et al. Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife for large superficial colorectal neoplasias including ileocecal lesions. Surg. Endosc. 24, 1941–1947 (2010).

    Article  PubMed  Google Scholar 

  48. Hussein, A. M., Bartram, C. I. & Williams, C. B. Carbon dioxide insufflation for more comfortable colonoscopy. Gastrointest. Endosc. 30, 68–70 (1984).

    Article  CAS  PubMed  Google Scholar 

  49. Stevenson, G. W., Wilson, J. A., Wilkinson, J., Norman, G. & Goodacre, R. L. Pain following colonoscopy: elimination with carbon dioxide. Gastrointest. Endosc. 38, 564–567 (1992).

    Article  CAS  PubMed  Google Scholar 

  50. Bretthauer, M. et al. NORCCAP (Norwegian colorectal cancer prevention): a randomised trial to assess the safety and efficacy of carbon dioxide versus air insufflation in colonoscopy. Gut 50, 604–607 (2002).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Kikuchi, T. et al. Transcutaneous monitoring of partial pressure of carbon dioxide during endoscopic submucosal dissection of early colorectal neoplasia with carbon dioxide insufflation: a prospective study. Surg. Endosc. 24, 2231–2235 (2010).

    Article  PubMed  Google Scholar 

  52. Nonaka, S. et al. Safety of carbon dioxide insufflation for upper gastrointestinal tract endoscopic treatment of patients under deep sedation. Surg. Endosc. 24, 1638–1645 (2010).

    Article  PubMed  Google Scholar 

  53. Saito, Y. et al. A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation. Gastrointest. Endosc. 65, 537–542 (2007).

    Article  PubMed  Google Scholar 

  54. Uemura, M., Ishii, N., Itoh, T., Suzuki, K. & Fujita, Y. Effects of carbon dioxide insufflation in esophageal endoscopic submucosal dissection. Hepatogastroenterology http://dx.doi.org/10.5754/hge11547.

  55. Katada, C. et al. Esophageal stenosis after endoscopic mucosal resection of superficial esophageal lesions. Gastrointest. Endosc. 57, 165–169 (2003).

    Article  PubMed  Google Scholar 

  56. Yamaguchi, N. et al. Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest. Endosc. 73, 1115–1121 (2011).

    Article  PubMed  Google Scholar 

  57. Isomoto, H. et al. Management of esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. BMC Gastroenterol. 11, 46 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  58. Hashimoto, S. et al. The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest. Endosc. 74, 1389–1393 (2011).

    Article  PubMed  Google Scholar 

  59. Yamaguchi, N. et al. Effect of oral prednisolone on esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma: a case report. Digestion 83, 291–295 (2011).

    Article  PubMed  Google Scholar 

  60. Sakamoto, N. et al. The facilitation of a new traction device (S-O clip) assisting endoscopic submucosal dissection for superficial colorectal neoplasms. Endoscopy 40 (Suppl. 2), E94–E95 (2008).

    Article  PubMed  Google Scholar 

  61. Sakamoto, N. et al. Endoscopic submucosal dissection of large colorectal tumours by using a novel spring-action, S-O clip for traction (with video). Gastrointest. Endosc. 69, 1370–1374 (2009).

    Article  PubMed  Google Scholar 

  62. Parra-Blanco, A. et al. Gastric endoscopic submucosal dissection assisted by a new traction method: the clip-band technique. A feasibility study in a porcine model (with video). Gastrointest. Endosc. 74, 1137–1141 (2011).

    Article  PubMed  Google Scholar 

  63. Oyama, T. Endoscopic submucosal dissection using a hook knife. Tech. Gastrointest. Endosc. 13, 70–73 (2011).

    Article  Google Scholar 

  64. Gotoda, T. et al. Prospective clinical trial of magnetic-anchor-guided endoscopic submucosal dissection for large early gastric cancer (with videos). Gastrointest. Endosc. 69, 10–15 (2009).

    Article  PubMed  Google Scholar 

  65. Sunada, K. & Yamamoto, H. Double-balloon endoscopy: past, present, and future. J. Gastroenterol. 44, 1–12 (2009).

    Article  PubMed  Google Scholar 

  66. Ishihara, R. et al. Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan. Gastrointest. Endosc. 68, 1066–1072 (2008).

    Article  PubMed  Google Scholar 

  67. Ono, S. et al. Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest. Endosc. 70, 860–866 (2009).

    Article  PubMed  Google Scholar 

  68. Nonaka, K. et al. Short term results of endoscopic submucosal dissection in superficial esophageal squamous cell neoplasms. World J. Gastrointest. Endosc. 2, 69–74 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  69. Takahashi, H. et al. Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest. Endosc. 72, 255–264, 264.e1–2 (2010).

    Article  PubMed  Google Scholar 

  70. Fujishiro, M. et al. Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin. Gastroenterol. Hepatol. 4, 688–694 (2006).

    Article  PubMed  Google Scholar 

  71. Oda, I. et al. Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from large consecutive series. Dig. Endosc. 17, 54–58 (2005).

    Article  Google Scholar 

  72. Oka, S. et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest. Endosc. 64, 877–883 (2006).

    Article  PubMed  Google Scholar 

  73. Watanabe, K. et al. Clinical outcomes of EMR for gastric tumors: historical pilot evaluation between endoscopic submucosal dissection and conventional mucosal resection. Gastrointest. Endosc. 63, 776–782 (2006).

    Article  PubMed  Google Scholar 

  74. Takenaka, R. et al. Risk factors associated with local recurrence of early gastric cancers after endoscopic submucosal dissection. Gastrointest. Endosc. 68, 887–894 (2008).

    Article  PubMed  Google Scholar 

  75. Goto, O., Fujishiro, M., Kodashima, S., Ono, S. & Omata, M. Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. Endoscopy 41, 118–122 (2009).

    Article  CAS  PubMed  Google Scholar 

  76. Isomoto, H. et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 58, 331–336 (2009).

    Article  CAS  PubMed  Google Scholar 

  77. Nakamoto, S. et al. Indications for the use of endoscopic mucosal resection for early gastric cancer in Japan: a comparative study with endoscopic submucosal dissection. Endoscopy 41, 746–750 (2009).

    Article  CAS  PubMed  Google Scholar 

  78. Yamamoto, S. et al. Endoscopic submucosal dissection for early gastric cancer performed by supervised residents: assessment of feasibility and learning curve. Endoscopy 41, 923–928 (2009).

    Article  PubMed  Google Scholar 

  79. Hotta, K. et al. A comparison of outcomes of endoscopic submucosal dissection (ESD) for early gastric neoplasms between high-volume and low-volume centers: multi-center retrospective questionnaire study conducted by the Nagano ESD Study Group. Intern. Med. 49, 253–259 (2010).

    Article  PubMed  Google Scholar 

  80. Abe, N. et al. Multicenter study of the long-term outcomes of endoscopic submucosal dissection for early gastric cancer in patients 80 years of age or older. Gastric Cancer 15, 70–75 (2011).

    Article  PubMed  Google Scholar 

  81. Akasaka, T. et al. Short-term outcomes of endoscopic submucosal dissection (ESD) for early gastric neoplasm: multicenter survey by Osaka University ESD study group. Dig. Endosc. 23, 73–77 (2011).

    Article  PubMed  Google Scholar 

  82. Gotoda, T., Iwasaki, M., Kusano, C., Seewald, S. & Oda, I. Endoscopic resection of early gastric cancer treated by guideline and expanded National Cancer Centre criteria. Br. J. Surg. 97, 868–871 (2010).

    Article  CAS  PubMed  Google Scholar 

  83. Ministry of Health, Labor and Welfare (Japan). Statistics of nationwide medical practices according to diagnostic and treatment category. Ministry of Health, Labor and Welfare [online], (Japanese).

  84. Isomoto, H. et al. Clinical outcomes of endoscopic submucosal dissection in elderly patients with early gastric cancer. Eur. J. Gastroenterol. Hepatol. 22, 311–317 (2010).

    Article  PubMed  Google Scholar 

  85. Niimi, K. et al. Long-term outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy 42, 723–729 (2010).

    Article  CAS  PubMed  Google Scholar 

  86. Nishiyama, H. et al. Endoscopic submucosal dissection for colorectal epithelial neoplasms. Dis. Colon Rectum 53, 161–168 (2010).

    Article  PubMed  Google Scholar 

  87. Saito, Y. et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest. Endosc. 72, 1217–1225 (2010).

    Article  PubMed  Google Scholar 

  88. Yoshida, N. et al. Outcome of endoscopic submucosal dissection for colorectal tumors in elderly people. Int. J. Colorectal Dis. 25, 455–461 (2010).

    Article  PubMed  Google Scholar 

  89. Cho, J. Y. & Cho, W. Y. Toward the global standardization of endoscopic submucosal dissection proposal for 10 years from now—present and future view of Korea. Dig. Endosc. 21 (Suppl. 1), S2–S3 (2009).

    Article  PubMed  Google Scholar 

  90. Ahn, J. Y. et al. Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest. Endosc. 74, 485–493 (2011).

    Article  PubMed  Google Scholar 

  91. Chun, H. J., Keum, B., Kim, J. H. & Seol, S. Y. Current status of endoscopic submucosal dissection for the management of early gastric cancer: a Korean perspective. World J. Gastroenterol. 17, 2592–2596 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  92. Chung, I. K. et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest. Endosc. 69, 1228–1235 (2009).

    Article  PubMed  Google Scholar 

  93. Jang, J. S. et al. Long-term outcomes of endoscopic submucosal dissection in gastric neoplastic lesions at a single institution in South Korea. Scand. J. Gastroenterol. 44, 1315–1322 (2009).

    Article  PubMed  Google Scholar 

  94. Jee, Y. S. et al. Safety of extended endoscopic mucosal resection and endoscopic submucosal dissection following the Japanese Gastric Cancer Association treatment guidelines. Br. J. Surg. 96, 1157–1161 (2009).

    Article  CAS  PubMed  Google Scholar 

  95. Kang, H. Y., Kim, S. G., Kim, J. S., Jung, H. C. & Song, I. S. Clinical outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Surg. Endosc. 24, 509–516 (2009).

    Article  PubMed  Google Scholar 

  96. Chang, C. C. et al. Endoscopic submucosal dissection for gastric epithelial tumors: a multicenter study in Taiwan. J. Formos Med. Assoc. 108, 38–44 (2009).

    Article  PubMed  Google Scholar 

  97. Chiu, H.-M., Lin, J.-T., Wu, M.-S. & Wang, H.-P. Current status and future perspective of endoscopic diagnosis and treatment for colorectal neoplasia—situation in Taiwan. Dig. Endosc. 21 (Suppl. 1), S17–S21 (2009).

    Article  PubMed  Google Scholar 

  98. Xu, L. H. et al. Treatment of gastric epithelial tumours by endoscopic submucosal dissection using an insulated-tip diathermic knife. Can. J. Gastroenterol. 25, 97–101 (2011).

    Article  PubMed  Google Scholar 

  99. Bourke, M. Current status of colonic endoscopic mucosal resection in the west and the interface with endoscopic submucosal dissection. Dig. Endosc. 21 (Suppl. 1), S22–S27 (2009).

    Article  PubMed  Google Scholar 

  100. Verna, E. C. & Larghi, A. Endoscopic submucosal dissection: learning from the Japanese experience. Dig. Liver Dis. 41, 210–211 (2009).

    Article  CAS  PubMed  Google Scholar 

  101. Neuhaus, H. Endoscopic submucosal dissection in the upper gastrointestinal tract: present and future view of Europe. Dig. Endosc. 21 (Suppl. 1), S4–S6 (2009).

    Article  PubMed  Google Scholar 

  102. Catalano, F. et al. The modern treatment of early gastric cancer: our experience in an Italian cohort. Surg. Endosc. 23, 1581–1586 (2009).

    Article  PubMed  Google Scholar 

  103. Dinis-Ribeiro, M. et al. A European case series of endoscopic submucosal dissection for gastric superficial lesions. Gastrointest. Endosc. 69, 350–355 (2009).

    Article  PubMed  Google Scholar 

  104. Ivanov, D. & Toyonaga, T. The first case of endoscopic submucosal dissection of cecal adenoma in Serbia [Serbian and English]. Med. Pregl. 62, 27–30 (2009).

    Article  PubMed  Google Scholar 

  105. Probst, A., Golger, D., Arnholdt, H. & Messman, H. Endoscopic submucosal dissection of early cancers, flat adenomas, and submucosal tumors in the gastrointestinal tract. Clin. Gastroenterol. Hepatol. 7, 149–155 (2009).

    Article  PubMed  Google Scholar 

  106. Chaves, D. M. et al. Endoscopic submucosal dissection for the treatment of early esophageal and gastric cancer—initial experience of a western center. Clinics (Sao Paulo) 65, 377–382 (2010).

    Article  Google Scholar 

  107. Coda, S. et al. A Western single-center experience with endoscopic submucosal dissection for early gastrointestinal cancers. Gastric Cancer 13, 258–263 (2010).

    Article  PubMed  Google Scholar 

  108. Probst, A. et al. Endoscopic submucosal dissection in gastric neoplasia—experience from a European center. Endoscopy 42, 1037–1044 (2010).

    Article  CAS  PubMed  Google Scholar 

  109. Deprez, P. H. et al. Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts. Endoscopy 42, 853–858 (2010).

    Article  CAS  PubMed  Google Scholar 

  110. Ribeiro-Mourao, F., Pimentel-Nunes, P. & Dinis-Ribeiro, M. Endoscopic submucosal dissection for gastric lesions: results of an European inquiry. Endoscopy 42, 814–819 (2010).

    Article  CAS  PubMed  Google Scholar 

  111. Repici, A. et al. Endoscopic submucosal dissection in patients with early esophageal squamous cell carcinoma: results from a prospective Western series. Gastrointest. Endosc. 71, 715–721 (2010).

    Article  PubMed  Google Scholar 

  112. Farhat, S. et al. Endoscopic submucosal dissection in a European setting. A multi-institutional report of a technique in development. Endoscopy 43, 664–670 (2011).

    Article  CAS  PubMed  Google Scholar 

  113. ASGE Technology Committee et al. Endoscopic mucosal resection and endoscopic submucosal dissection. Gastrointest. Endosc. 68, 11–18 (2008).

  114. Ho, K. Y. et al. Endoscopic submucosal dissection of gastric lesions by using a Master and Slave Transluminal Endoscopic Robot (MASTER). Gastrointest. Endosc. 72, 593–599 (2010).

    Article  PubMed  Google Scholar 

  115. Spaun, G. O., Zheng, B. & Swanstrom, L. L. A multitasking platform for natural orifice translumenal endoscopic surgery (NOTES): a benchtop comparison of a new device for flexible endoscopic surgery and a standard dual-channel endoscope. Surg. Endosc. 23, 2720–2727 (2009).

    Article  PubMed  Google Scholar 

  116. Clayman, R. V. et al. Rapid communication: transvaginal single-port NOTES nephrectomy: initial laboratory experience. J. Endourol. 21, 640–644 (2007).

    Article  PubMed  Google Scholar 

  117. Bardaro, S. J. & Swanstrom, L. Development of advanced endoscopes for Natural Orifice Transluminal Endoscopic Surgery (NOTES). Minim. Invasive Ther. Allied Technol. 15, 378–383 (2006).

    Article  PubMed  Google Scholar 

  118. Thompson, C. C. et al. Evaluation of a manually driven, multitasking platform for complex endoluminal and natural orifice transluminal endoscopic surgery applications (with video). Gastrointest. Endosc. 70, 121–125 (2009).

    Article  PubMed  Google Scholar 

  119. Spaun, G. O. et al. Bimanual coordination in natural orifice transluminal endoscopic surgery: comparing the conventional dual-channel endoscope, the R-Scope, and a novel direct-drive system. Gastrointest. Endosc. 69, e39–e45 (2009).

    Article  PubMed  Google Scholar 

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  1. Department of Medicine, Division of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Tochigi, Japan

    Hironori Yamamoto

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H. Yamamoto is a consultant, is on the speakers bureau, receives grant/research support and is a patent holder/applicant for Fujifilm Corporation. He is a consultant and patent holder/applicant for Seikagaku Corporation.

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Yamamoto, H. Endoscopic submucosal dissection—current success and future directions. Nat Rev Gastroenterol Hepatol 9, 519–529 (2012). https://doi.org/10.1038/nrgastro.2012.97

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