Advantages of endoscopic submucosal dissection over conventional endoscopic mucosal resection

Abstract

Endoscopic submucosal dissection can take a long time, but is superior to conventional endoscopic mucosal resection for treating intramucosal gastric neoplasms.

Risk factors for bleeding after gastric endoscopic submucosal dissection: a systematic review and meta-analysis

“…Tumor size and resected specimen size were evaluated as risk factors in several studies. Lesion sizes > 10 mm 55 and >20 mm 43,56 were not found to increase PPB in some studies, whereas lesion sizes > 20 mm, 20,22,39,[57][58][59] >30 mm, 39 and >40 mm 58 were found to be associated with higher PPB risk in others. Regarding specimen size, the larger the ulcer, the higher the risk, with an artificial ulcer > 30 mm, 36 34 mm,…”

“…30,58 However, several studies reported no significant differences in PPB according to tumor location. [14][15][16][17][18][20][21][22][23][24][25][26][27][28][29]32,39,42,43,51,55,61 Horizontal localization (anterior or posterior wall; lesser or greater curvature) was not found to influence PPB in individual studies. [15][16][17][20][21][22][23][24]27,29 Regarding the relationship between…”

“…Submucosal invasion and fibrosis/scarring were not found to influence PPB despite a tendency for higher bleeding in the latter situation. Concerning EMR, 3 studies did not identify size and location, 55 indication, 64 or ulceration 66 as risk factors for PPB and were not included in the meta-analysis.…”

Efficacy and Safety of Endoscopic Submucosal Dissection for Early Gastric Cancer in Patients with Comorbid Diseases

“…5 In contrast to EMR, endoscopic submucosal dissection (ESD) can resect lesions larger than 2 cm en bloc and reduce local recurrence. [6][7][8][9] But ESD may also cause serious complications such as bleeding or perforation more frequently than conventional EMR. [5][6][7]10 As life expectancy has increased because of better living conditions and improvements in the treatment of chronic disease, more patients who undergo ESD have one or more chronic diseases.…”

Secondary endoscopic submucosal dissection for residual or recurrent tumors after gastric endoscopic submucosal dissection

“…Therapies involving ESD have a higher rate of complete resection (R0) and lower rate of local recurrence than conventional EMR [6][7][8][9][10][11]. However, the fact that ESD is carried out for difficult-to-resect tumors has caused the new, though infrequent, problem of post-ESD local residual or recurrent tumors, the characteristics of which are poorly understood.…”