EMR/ESD for intraepithelial neoplasia in GI tract

EMR/ESD is an endoscopic technique of mucosal resection. By that technique, intraepithelial neoplasia in gastrointestinal tract can be removed by non-surgical minimally invasive technique. EMR-"Cap" technique has been launched in 1989 by the present authors as a convenient technique of EMR. EMR-Cap technique is a quick procedure, enable to be applied to any part of the GI tract, but the size of the resected specimen is limited to 2cm. In order to get en-bloc specimen for widespread lesion, triangle-tip electrocautery knife (TT knife) was newly designed to effectively perform endoscopic submucosal dissection (ESD). It passes through the working channel of the regular endoscope. TT knife allows all processes of ESD including marking. marginal cutting, submucosal dissection and hemostasis. From September 2003, 324 consecutive cases (258 cases in the stomach, 66 cases in the esophagus) received ESD using TT knife. In 317 cases, ESD was completed with no serious complications. In the 7 other cases ESD switched to EMR-C procedure resulting in multi-fragment resection due to technical difficulty in completing ESD. All converted cases were our initial series of ESD on our learning curve. We consider that EMR-C is a quick procedure to resect less than 2cm specimen and ESD using TT knife can be applied to resect widespread lesion. Both techniques allow en-bloc resection of GI intraepithelial neoplasia which contributes to precise histopathological evaluation.