Endoscopic mucosal resection for esophageal cancer

Endoscopic mucosal resection (EMR) is at present the only endoscopic ablation treatment that provides a specimen for histologic analysis. By histologic precise evaluation of the resected specimen, the final treatment strategy for the disease can be decided. Generally, mucosal cancer with no lymph node metastasis is the best candidate for this procedure. We developed a technique of EMR by using a transparent plastic cap (EMRC) in 1992. By using this technique, any part of esophageal mucosa can be easily accessed and safely resected. In this chapter, we discuss indications for EMR, technical details of the EMRC procedure, our clinical results, and how to prevent complications. From 1989 to 2000, we have performed more than 250 cases of EMR in the esophagus. One perforation occurred in the esophagus. Insufficient submucosal saline injection was considered to be a major factor leading to the perforation. Therefore, large-volume injection is strongly recommended because it creates a large bleb and potentially reduces the risk of muscle involvement. By careful adherence to this point, EMR can be safely performed in any part of the esophagus by using a cap.