EMR and ESD for Gastrointestinal Neoplasms

Surgery is the accepted standard treatment of early gastrointestinal cancer, defined as cancer with involvement confined to the mucosa or submucosa, regardless of the size or the presence of regional lymph-node metastases. However, recent progress in endoscopic technique has made it possible to treat gastrointestinal neoplasm. For example, early gastric cancer confined to the mucosa can be treated successfully with endoscopic resection alone. Endoscopic resection of early gastric cancer originated with the development of a polypectomy technique using high-frequency current for gastric polyps in 1968 (Niwa 1968), and has become popular as endoscopic mucosal resection (EMR) since the birth of the strip biopsy method in 1984 (Tada et al. 1984). Endoscopic submucosal dissection (ESD) is a new endoscopic technique using cutting devices that developed from one of the EMR techniques, namely endoscopic resection after local injection of a solution of hypertonic salineepinephrine (Hirano et al. 1988). EMR has recently been replaced by endoscopic submucosal dissection (ESD), because en bloc resection of specimens >20 mm in diameter is difficult to achieve with EMR, and piecemeal resection is associated with increased rates of local recurrence to about 15% (Muto et al. 2005, Oka et al. 2006). The technique of ESD was introduced to resect large specimens of early gastric cancer in a single piece. But, the question remains as to whether ESD is superior to EMR in all regards. This chapter provides an overview of EMR and ESD.