Endoscopic submucosal dissection in upper gastrointestinal lesions

Objective To assess the effectiveness and safety of the technique of endoscopic submucosal dissection （ESD） in upper gastrointestinal lesions. Methods The patients with mucosal or submucosal lesions of upper gastrointestinal tract detected by gastroscopy were enrolled. Endoscopic uhrasonography and/ or biopsy were applied to confirm the size, location, and nature of the lesions. The procedure of ESD, involving the use of hook knife, insulation-tipped diathermic knife （ IT knife）, and high-frequency electric coagulation, was as follows ： first, identified the lesions by gastroscopy or mucosal staining and marked it with needle knife or argon plasma coagulation （APC） ; second, raised the submucosa through submucosal injection of indigo carmine and diluted epinephrine. Then, pre-cut the circumferential mucosa of the target lesion ; finally, completely dissected along the submucosal layer. Acid-suppressing and mucosal protection agents were administered postoperatively. Follow-up endoscopy was taken at 1, 2, 6 months after ESD to evaluate the progression of the lesions. Results A total of 153 cases were enrolled from August 2006 to January 2008, of which 85 were mucosal lesions and 68 were submucosal ones. The mucosal lesions included 2 cases of ulcerating type, 48 of protruding type, and 35 of erosive type, with the diameter ranging from 0. 4 to 5.0 cm （mean 2. 0 cm）. All the mucosal lesions were dissected through endoscopy, with the operation time ranging from 15 to 210 minutes （mean 55 minutes）. One patient received emergency endoscopic hemostasis because of delayed hemorrhage, seven others were treated conservatively because of perforation. All the wound sur- faces healed during the follow-up, including 4 cases of recurrence, of which 3 received second ESD, and 1 was referred to surgery. Among the submucosal lesions, 52 cases underwent endoscopic ultrasonography before ESD, and the others were diagnosed by postoperative histology. The diameter of the lesion ranged from 0. 4 to 4. 0 cm （mean 1.2 cm）. All the submucosal lesions were removed completely in 10 to 182 minutes （mean 41 min）, except one patient was treated by endoscopic nylon tigation. Eleven patients were treated conservatively because of perforation, and one received surgery because of the uncontrolled bleeding. Conelusion As a minimally invasive method, ESD may present a novel and promising procedure in treating mucosal or submucosal lesions of upper gastrointestinal tract, with the advantage of achieving large en-bloc resections, low recurrence rate, and few complications. Key words: Gastrointestinal tract ;  Endoscopes ;  Therapy ;  Endoscopic submucosal dissection