Nishizawa Toshihiro, Yahagi Naohisa
aDivision of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine bDivision of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
Curr Opin Gastroenterol. 2017 Sep;33(5):315-319. doi: 10.1097/MOG.0000000000000388.
Most of small tumours in gastrointestinal tract are easily removed by endoscopic mucosal resection (EMR). However, EMR are sometimes not reliable to ensure the complete resection for large tumours. Although endoscopic submucosal dissection (ESD) was developed, it had a higher risk for complications such as perforation and bleeding. The techniques and clinical outcomes of EMR and ESD are reviewed.
ESD is more effective for early gastric and oesophageal cancer with higher en-bloc resection rate and lower local recurrence in comparison to EMR. Several studies report favourable long-term outcomes of ESD. ESD has become a standard technique in Japan and other East Asian countries. Piecemeal resection using EMR technique is widely accepted for colorectal large adenomas and results in good clinical outcomes in most patients. However, apparent cancerous lesions need endoscopic en-bloc resection by ESD.
Further development of the technique, devices and training systems will promote worldwide standardization of ESD.
胃肠道大多数小肿瘤可通过内镜黏膜切除术（EMR）轻松切除。然而，对于大肿瘤，EMR有时无法确保完整切除。尽管内镜黏膜下剥离术（ESD）已得到发展，但它有更高的穿孔和出血等并发症风险。本文对EMR和ESD的技术及临床结果进行综述。
与EMR相比，ESD对早期胃癌和食管癌更有效，整块切除率更高，局部复发率更低。多项研究报告了ESD良好的长期结果。ESD在日本和其他东亚国家已成为标准技术。使用EMR技术的分片切除在结直肠大腺瘤中被广泛接受，大多数患者临床结果良好。然而，明显的癌性病变需要通过ESD进行内镜整块切除。
技术、设备和培训系统的进一步发展将推动ESD在全球的标准化。
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