| Theme |
Future Perspectives of Therapeutic Endoscopy Such as ESD and NOTES |
| Title |
Current Status of and Problems with ESD for Esophageal Carcinomas |
| Author |
Yuichi Shimizu |
Department of Gastroenterology, Hokkaido University |
| Author |
Takeshi Yoshida |
Department of Gastroenterology, Hokkaido University |
| Author |
Mototsugu Kato |
Division of Endoscopy, Hokkaido University |
| Author |
Shoko Ono |
Division of Endoscopy, Hokkaido University |
| Author |
Masahiro Asaka |
Department of Gastroenterology, Hokkaido University |
| [ Summary ] |
Recently, the development of techniques for endoscopic diagnosis have led to the detection of increasing numbers of early-stage esophageal squamous cell carcinomas. Endoscopic submucosal dissection (ESD) has become increasingly popular as a first choice for treatment for patients with early-stage esophageal carcinoma because of its minimal invasiveness and satisfactory outcomes. However, some problems still remain to be solved. We can use many kinds of devices for ESD. However, no device has been established as the gold standard for treatment. Factors associated with the occurrence and severity of esophageal stenosis after endoscopic resection have lead to the conclusion that a circumferential mucosal defect involving two thirds to three fourths of the circumference of the esophagus is significantly associated with subsequent development of esophageal stenosis. A stenotic esophagus after endoscopic resection can be dilated to some degree with endoscopic balloon dilation. However, preventive treatment for recurrence of esophageal stenosis is still under clinical study. Effective conscious sedation for esophageal ESD is also under clinical study. Indications for T1a-MM and SM1 tumors are rather controversial. Good long-term outcomes after ESD can be expected for patients with these tumors. However, decisions concerning additional treatment are still difficult. |