[Submucosal endoscopic dissection].

BACKGROUND

Endoscopic submucosal dissection (ESD) is a novel technique that increases the therapeutic spectrum for early-stage malignant lesions (T1mN0) of gastrointestinal tract.

AIM

To review the current training requirements, indications and devices for ESD.

METHODS

A PubMed search and selection for manuscripts between 2005 and 2009 was performed. Kew words used were of "endoscopic submucosal dissection", "indications", "training" and "devices".

RESULTS

Indications for ESD in early gastrointestinal cancer are: I) Well differentiated and limited to mucosa: a) Non ulcerated: no matters size and shape or, b) Ulcerated: less than 3 cm; II) Poorly-differentiated limited to mucosa: non ulcerated and less than 2 cm; III) Invading submucosa: well differentiated, less than 3 cm with a maximum depth of 500 µm. The most frequently used technique to elevate submucosa is injection of isotonic saline solution with epinephrine and indigo. Technology is evolving with new devices for increasing safety. Training should include at least 30 animal models before attempting to perform the procedure in patients.

CONCLUSIONS

ESD is an endoscopic procedure with well established indications that require a special training. Its use in well selected cases is safe and can replace a surgical procedure or other therapeutic modalities.