Turkish Journal of Gastroenterology
Original Article

Process of technical stabilization of gastric endoscopic submucosal dissection at the National Cancer Center in Japan


Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

Turk J Gastroenterol 2014; 25: 619-623
DOI: 10.5152/tjg.2014.14077
Read: 1665 Downloads: 701 Published: 25 July 2019


Background/Aims: Endoscopic submucosal dissection (ESD) was originally developed in 1995 using an insulation-tipped diathermic knife (Olympus, Tokyo, Japan) to achieve en-bloc resection of early gastric cancer (EGC). It has been suggested that advances in endoscopic devices and medical equipment, such as the high-frequency generator (1999) and hemostatic forceps (2000), and procedural improvements including post-ESD preventive coagulation of visible vessels in the resection area (2003) led to further progress of ESD; therefore, we investigated the actual process of technical stabilization of gastric ESD.


Materials and Methods: A total of 1,713 consecutive patients with solitary differentiated-type EGC at initial onset underwent ESD at our hospital from 1995 to 2006. We retrospectively assessed ESD outcomes for all patients by dividing them into three chronological periods: 1995-1998 (1st period; 57 patients), 1999-2002 (2nd period; 563 patients), and 2003-2006 (3rd period; 1,093 patients).


Results: The en-bloc resection, intraoperative bleeding, and delayed bleeding in the 1st/2nd/3rd period were 52.6%/94.7%/99.3% (1st vs. 2nd, p<0.01; 2nd vs. 3rd, p<0.01), 8.8%/7.1%/1.6% (1st vs. 2nd, no significant difference; 2nd vs. 3rd, p<0.01), and 15.8%/7.6%/3.3% (1st vs. 2nd, p<0.05; 2nd vs. 3rd, p<0.01), respectively.



Conclusion: Gastric ESD has stabilized technically following advances in endoscopic devices and medical equipment together with procedural improvements.

EISSN 2148-5607