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J.Jpn. Surg. Soc.. 109(1): 10-14, 2008

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Department of Surgery, School of Medicine, Tokai University, Kanagawa, Japan

Hideo Shimada, Hiroyasu Makuuchi, Osamu Chino, Takayuki Nishi, Yoshifumi Kise, Tomoko Hanashi, Soichiro Yamamoto, Tadashi Hara

The indications for endoscopic treatment are limited to cases without lymph node metastasis, because it is only a local therapy. The relationship between cancer depth and lymph node metastasis has been clarified based on the pathologic analysis of lymph nodes removed during esophagectomy for early esophageal cancer. Cancer confined to the lamina propria mucosa rarely undergoes lymph node metastasis and complete endoscopic resection (ER) is indicated. ER allows the esophagus to be preserved and is less invasive, enabling specimens to be pathologically examined. Lesions extending over large area can be resected by repeating endoscopic mucosal resection (EMR), but have recently been resected using endoscopic submucosal dissection (ESD), as indicated for gastric cancer. Which of the two procedures, EMR or ESD, to be chosen depends on the difficulty, skill of the surgeon, time to be spared, and economic management. ER is now performed in SM1 without lymph node metastasis, although some patients require additional treatment after pathologic examination of resected lesions.

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