Endoscopic submucosal dissection for early gastric adenocarcinoma: a review of the literature

Endoscopic submucosal dissection (ESD) is an effective technique in high volume centers for early gastric cancers, which are defined as T1 tumors confined to the mucosa or submucosa. ESD relies on accurate pre-procedural staging to identify localized lesions that do not have lymph node involvement; absolute and extended criteria guidelines exist to assist in patient selection. In patients that undergo en bloc resection, overall survival and disease free survival are equivalent to formal surgical resection. Local and metachronous recurrences occur in approximately 1% and 5% of cases respectively, and long-term endoscopic surveillance is required. The post-procedural complications include bleeding (5%) and perforation (1–9%) and are dependent on tumor and operator factors. Patients whose lesions do not meet resection criteria on final pathology are referred for surgical resection. This article reviews the current evidence on patient selection, endoscopic technique and complications, and outcomes for ESD in patients with early gastric cancer.