UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Overview of endoscopic resection of gastrointestinal tumors

Authors
Naresh T Gunaratnam, MD
Mustafa Kathawala, MD
Christopher Gostout, MD
Section Editor
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

Endoscopic resection (ER) is an endoscopic alternative to surgical resection of mucosal and submucosal neoplastic lesions and intramucosal cancers [1]. ER includes endoscopic mucosal resection (EMR), which involves snare resection of dysplastic lesions, and endoscopic submucosal dissection (ESD) in which endoscopic tools are used to dissect lesions from the submucosa. ER offers both diagnostic and therapeutic capability. Lesions limited to the mucosa and the superficial layers of the submucosa appear to be the most amenable to endoscopic cure.

This topic will provide an overview of ER for gastrointestinal tumors. Additional information on ER for the removal of superficial esophageal cancer, high-grade dysplasia in patients with Barrett's esophagus, early gastric cancer, and large colon polyps can be found elsewhere. (See "Management of superficial esophageal cancer" and "Barrett's esophagus: Treatment of high-grade dysplasia or early cancer with endoscopic resection" and "Early gastric cancer: Epidemiology, clinical manifestations, diagnosis, and staging" and "Endoscopic removal of large colon polyps".)

LESION CLASSIFICATION

The greatest experience with ER has come from Japan, where the Japanese Society for Gastroenterological Endoscopy (JSGE) has developed a classification system based upon visual and endosonographic features. The system was developed in an attempt to codify the indications and outcomes related to ER [2]. Although it was developed for early gastric cancer, it can also be applied to cancers at other sites in the gastrointestinal tract. The system recognizes four types of early endoluminal cancers (table 1 and figure 1):

Type I lesions are polypoid or protuberant and are subcategorized as:

Ip – pedunculated

                         

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Feb 04 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Technology status report evaluation. Endoscopic mucosal resection. Gastrointest Endosc 2000; 52:860.
  2. The general rules for The gastric cancer study in surgery. Jpn J Surg 1973; 3:61.
  3. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58:S3.
  4. Takeshita K, Tani M, Inoue H, et al. Endoscopic treatment of early oesophageal or gastric cancer. Gut 1997; 40:123.
  5. Soehendra N, Binmoeller KF, Bohnacker S, et al. Endoscopic snare mucosectomy in the esophagus without any additional equipment: a simple technique for resection of flat early cancer. Endoscopy 1997; 29:380.
  6. Hamada T, Kondo K, Itagaki Y, Nishida J. [Endoscopic mucosal resection for early gastric cancer]. Nihon Rinsho 1996; 54:1292.
  7. Endo M, Takeshita K, Inoue H. [Endoscopic mucosal resection of esophageal cancer]. Gan To Kagaku Ryoho 1995; 22:192.
  8. Pacifico RJ, Wang KK, Wongkeesong LM, et al. Combined endoscopic mucosal resection and photodynamic therapy versus esophagectomy for management of early adenocarcinoma in Barrett's esophagus. Clin Gastroenterol Hepatol 2003; 1:252.
  9. Suzuki H, Masuda K, Fujisaki J, Okuwaki S. [Endoscopic treatment of gastrointestinal cancers--indication and limitation]. Nihon Rinsho 1996; 54:1699.
  10. Makuuchi H. Endoscopic mucosal resection for early esophageal cancer: Indications and techniques. Dig Endosc 1996; 8:175.
  11. Yoshida M, Hanashi T, Momma K, et al. [Endoscopic mucosal resection for radical treatment of esophageal cancer]. Gan To Kagaku Ryoho 1995; 22:847.
  12. Pech O, Gossner L, May A, et al. Endoscopic resection of superficial esophageal squamous-cell carcinomas: Western experience. Am J Gastroenterol 2004; 99:1226.
  13. Tanabe S, Koizumi W, Higuchi K, et al. Clinical outcomes of endoscopic oblique aspiration mucosectomy for superficial esophageal cancer. Gastrointest Endosc 2008; 67:814.
  14. Seewald S, Akaraviputh T, Seitz U, et al. Circumferential EMR and complete removal of Barrett's epithelium: a new approach to management of Barrett's esophagus containing high-grade intraepithelial neoplasia and intramucosal carcinoma. Gastrointest Endosc 2003; 57:854.
  15. Peters FP, Kara MA, Rosmolen WD, et al. Endoscopic treatment of high-grade dysplasia and early stage cancer in Barrett's esophagus. Gastrointest Endosc 2005; 61:506.
  16. Wani S, Sayana H, Sharma P. Endoscopic eradication of Barrett's esophagus. Gastrointest Endosc 2010; 71:147.
  17. Merkow RP, Bilimoria KY, Keswani RN, et al. Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer. J Natl Cancer Inst 2014; 106.
  18. Ell C, May A, Gossner L, et al. Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus. Gastroenterology 2000; 118:670.
  19. Raju GS, Waxman I. High-frequency US probe sonography-assisted endoscopic mucosal resection. Gastrointest Endosc 2000; 52:S39.
  20. Kojima T, Parra-Blanco A, Takahashi H, Fujita R. Outcome of endoscopic mucosal resection for early gastric cancer: review of the Japanese literature. Gastrointest Endosc 1998; 48:550.
  21. Schlemper RJ, Itabashi M, Kato Y, et al. Differences in diagnostic criteria for gastric carcinoma between Japanese and western pathologists. Lancet 1997; 349:1725.
  22. Makuuchi H, Kise Y, Shimada H, et al. Endoscopic mucosal resection for early gastric cancer. Semin Surg Oncol 1999; 17:108.
  23. Białek A, Wiechowska-Kozłowska A, Pertkiewicz J, et al. Endoscopic submucosal dissection for treatment of gastric subepithelial tumors (with video). Gastrointest Endosc 2012; 75:276.
  24. Joo MK, Park JJ, Kim H, et al. Endoscopic versus surgical resection of GI stromal tumors in the upper GI tract. Gastrointest Endosc 2016; 83:318.
  25. Karita M, Tada M, Okita K, Kodama T. Endoscopic therapy for early colon cancer: the strip biopsy resection technique. Gastrointest Endosc 1991; 37:128.
  26. Shirai M, Nakamura T, Matsuura A, et al. Safer colonoscopic polypectomy with local submucosal injection of hypertonic saline-epinephrine solution. Am J Gastroenterol 1994; 89:334.
  27. Yokota T, Sugihara K, Yoshida S. Endoscopic mucosal resection for colorectal neoplastic lesions. Dis Colon Rectum 1994; 37:1108.
  28. Kanamori T, Itoh M, Yokoyama Y, Tsuchida K. Injection-incision--assisted snare resection of large sessile colorectal polyps. Gastrointest Endosc 1996; 43:189.
  29. Puli SR, Kakugawa Y, Saito Y, et al. Successful complete cure en-bloc resection of large nonpedunculated colonic polyps by endoscopic submucosal dissection: a meta-analysis and systematic review. Ann Surg Oncol 2009; 16:2147.
  30. Niimi K, Fujishiro M, Kodashima S, et al. Long-term outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy 2010; 42:723.
  31. Saito Y, Uraoka T, Yamaguchi Y, et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 2010; 72:1217.
  32. Young PE, Gentry AB, Acosta RD, et al. Endoscopic ultrasound does not accurately stage early adenocarcinoma or high-grade dysplasia of the esophagus. Clin Gastroenterol Hepatol 2010; 8:1037.
  33. Conio M, Rajan E, Sorbi D, et al. Comparative performance in the porcine esophagus of different solutions used for submucosal injection. Gastrointest Endosc 2002; 56:513.
  34. Fujishiro M, Yahagi N, Kashimura K, et al. Different mixtures of sodium hyaluronate and their ability to create submucosal fluid cushions for endoscopic mucosal resection. Endoscopy 2004; 36:584.
  35. Fujishiro M, Yahagi N, Kashimura K, et al. Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection. Endoscopy 2004; 36:579.
  36. Lee SH, Park JH, Park DH, et al. Clinical efficacy of EMR with submucosal injection of a fibrinogen mixture: a prospective randomized trial. Gastrointest Endosc 2006; 64:691.
  37. Yamamoto H, Yahagi N, Oyama T, et al. Usefulness and safety of 0.4% sodium hyaluronate solution as a submucosal fluid "cushion" in endoscopic resection for gastric neoplasms: a prospective multicenter trial. Gastrointest Endosc 2008; 67:830.
  38. Feitoza AB, Gostout CJ, Burgart LJ, et al. Hydroxypropyl methylcellulose: A better submucosal fluid cushion for endoscopic mucosal resection. Gastrointest Endosc 2003; 57:41.
  39. Polymeros D, Kotsalidis G, Triantafyllou K, et al. Comparative performance of novel solutions for submucosal injection in porcine stomachs: An ex vivo study. Dig Liver Dis 2010; 42:226.
  40. Hirao M, Masuda K, Asanuma T, et al. Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine. Gastrointest Endosc 1988; 34:264.
  41. Yamamoto H, Yube T, Isoda N, et al. A novel method of endoscopic mucosal resection using sodium hyaluronate. Gastrointest Endosc 1999; 50:251.
  42. Narahara H, Iishi H, Tatsuta M, et al. Effectiveness of endoscopic mucosal resection with submucosal saline injection technique for superficial squamous carcinomas of the esophagus. Gastrointest Endosc 2000; 52:730.
  43. Lee SH, Cho WY, Kim HJ, et al. A new method of EMR: submucosal injection of a fibrinogen mixture. Gastrointest Endosc 2004; 59:220.
  44. Kähler GF, Sold MS, Post S, et al. Selective tissue elevation by pressure injection (STEP) facilitates endoscopic mucosal resection (EMR). Surg Technol Int 2007; 16:107.
  45. Katsinelos P, Kountouras J, Paroutoglou G, et al. A comparative study of 50% dextrose and normal saline solution on their ability to create submucosal fluid cushions for endoscopic resection of sessile rectosigmoid polyps. Gastrointest Endosc 2008; 68:692.
  46. Sumiyama K, Tajiri H, Gostout CJ, et al. Chemically assisted submucosal injection facilitates endoscopic submucosal dissection of gastric neoplasms. Endoscopy 2010; 42:627.
  47. Sumiyama K, Gostout CJ, Rajan E, et al. Chemically assisted endoscopic mechanical submucosal dissection by using mesna. Gastrointest Endosc 2008; 67:534.
  48. Poppers DM, Haber GB. Endoscopic mucosal resection of colonic lesions: current applications and future prospects. Med Clin North Am 2008; 92:687.
  49. Fleischer DE, Wang GQ, Dawsey S, et al. Tissue band ligation followed by snare resection (band and snare): a new technique for tissue acquisition in the esophagus. Gastrointest Endosc 1996; 44:68.
  50. Yoshikane H, Hidano H, Sakakibara A, et al. Endoscopic resection of laterally spreading tumours of the large intestine using a distal attachment. Endoscopy 1999; 31:426.
  51. Inoue H, Kawano T, Tani M, et al. Endoscopic mucosal resection using a cap: techniques for use and preventing perforation. Can J Gastroenterol 1999; 13:477.
  52. Akiyama M, Ota M, Nakajima H, et al. Endoscopic mucosal resection of gastric neoplasms using a ligating device. Gastrointest Endosc 1997; 45:182.
  53. Noda M, Kobayashi N, Kanemasa H, et al. Endoscopic mucosal resection using a partial transparent hood for lesions located tangentially to the endoscope. Gastrointest Endosc 2000; 51:338.
  54. Tada M, Murata M, Murakami F, et al. Development of the strip-off biopsy [in Japanese with English abstract]. Gastrointest Endosc 1984; 26:833.
  55. Matsushita M, Hajiro K, Okazaki K, Takakuwa H. Endoscopic mucosal resection of gastric tumors located in the lesser curvature of the upper third of the stomach. Gastrointest Endosc 1997; 45:512.
  56. Takekoshi T, Fujii A, Takagi K, et al. [Radical endoscopic treatment of early gastric cancer-indication for and evaluation of endoscopic resection]. Gan To Kagaku Ryoho 1988; 15:1449.
  57. Yamamoto H, Koiwai H, Yube T, et al. A successful single-step endoscopic resection of a 40 millimeter flat-elevated tumor in the rectum: endoscopic mucosal resection using sodium hyaluronate. Gastrointest Endosc 1999; 50:701.
  58. Kume K. Endoscopic mucosal resection and endoscopic submucosal dissection for early gastric cancer: Current and original devices. World J Gastrointest Endosc 2009; 1:21.
  59. Rajan E, Gostout CJ. Future developments of EMR, techniques and devices. Techniques in Gastrointest Endosc 2002; 4:51.
  60. Bedogni G, Bertoni G, Ricci E, et al. Colonoscopic excision of large and giant colorectal polyps. Technical implications and results over eight years. Dis Colon Rectum 1986; 29:831.
  61. Vazquez-Sequeiros E, Geller A, Geller N, et al. Polypectomy of large polyps (>2cm): Efficacy and safety (abstract). Gastrointest Endosc 2000; 51:AB101.
  62. Ono H. Endoscopic submucosal dissection for early gastric cancer. Chin J Dig Dis 2005; 6:119.
  63. Gotoda T. A large endoscopic resection by endoscopic submucosal dissection procedure for early gastric cancer. Clin Gastroenterol Hepatol 2005; 3:S71.
  64. Yamamoto H, Yahagi N, Oyama T. Mucosectomy in the colon with endoscopic submucosal dissection. Endoscopy 2005; 37:764.
  65. Oyama T, Tomori A, Hotta K, et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 2005; 3:S67.
  66. Fujishiro M, Yahagi N, Nakamura M, et al. Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar. Gastrointest Endosc 2006; 63:243.
  67. Kim JH, Lee YC, Kim H, et al. Endoscopic resection for undifferentiated early gastric cancer. Gastrointest Endosc 2009; 69:e1.
  68. Nakamoto S, Sakai Y, Kasanuki J, et al. Indications for the use of endoscopic mucosal resection for early gastric cancer in Japan: a comparative study with endoscopic submucosal dissection. Endoscopy 2009; 41:746.
  69. Fujishiro M, Yahagi N, Kakushima N, et al. Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol 2007; 5:678.
  70. Byeon JS, Yang DH, Kim KJ, et al. Endoscopic submucosal dissection with or without snaring for colorectal neoplasms. Gastrointest Endosc 2011; 74:1075.
  71. Hayashi N, Tanaka S, Nishiyama S, et al. Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors. Gastrointest Endosc 2014; 79:427.
  72. Fujishiro M, Yahagi N, Kakushima N, et al. Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol 2006; 4:688.
  73. Yoshinaga S, Gotoda T, Kusano C, et al. Clinical impact of endoscopic submucosal dissection for superficial adenocarcinoma located at the esophagogastric junction. Gastrointest Endosc 2008; 67:202.
  74. Ono S, Fujishiro M, Niimi K, et al. Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc 2009; 70:860.
  75. Higuchi K, Tanabe S, Azuma M, et al. A phase II study of endoscopic submucosal dissection for superficial esophageal neoplasms (KDOG 0901). Gastrointest Endosc 2013; 78:704.
  76. Chevaux JB, Piessevaux H, Jouret-Mourin A, et al. Clinical outcome in patients treated with endoscopic submucosal dissection for superficial Barrett's neoplasia. Endoscopy 2015; 47:103.
  77. Probst A, Aust D, Märkl B, et al. Early esophageal cancer in Europe: endoscopic treatment by endoscopic submucosal dissection. Endoscopy 2015; 47:113.
  78. Li QL, Yao LQ, Zhou PH, et al. Submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a large study of endoscopic submucosal dissection (with video). Gastrointest Endosc 2012; 75:1153.
  79. Jung JH, Choi KD, Ahn JY, et al. Endoscopic submucosal dissection for sessile, nonampullary duodenal adenomas. Endoscopy 2013; 45:133.
  80. Matsumoto S, Miyatani H, Yoshida Y. Endoscopic submucosal dissection for duodenal tumors: a single-center experience. Endoscopy 2013; 45:136.
  81. Maruoka D, Arai M, Kishimoto T, et al. Clinical outcomes of endoscopic resection for nonampullary duodenal high-grade dysplasia and intramucosal carcinoma. Endoscopy 2013; 45:138.
  82. Cao Y, Liao C, Tan A, et al. Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy 2009; 41:751.
  83. Rösch T, Sarbia M, Schumacher B, et al. Attempted endoscopic en bloc resection of mucosal and submucosal tumors using insulated-tip knives: a pilot series. Endoscopy 2004; 36:788.
  84. Takenaka R, Kawahara Y, Okada H, et al. Risk factors associated with local recurrence of early gastric cancers after endoscopic submucosal dissection. Gastrointest Endosc 2008; 68:887.
  85. Park YM, Cho E, Kang HY, Kim JM. The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and metaanalysis. Surg Endosc 2011; 25:2666.
  86. Lian J, Chen S, Zhang Y, Qiu F. A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc 2012; 76:763.
  87. Park JC, Lee SK, Seo JH, et al. Predictive factors for local recurrence after endoscopic resection for early gastric cancer: long-term clinical outcome in a single-center experience. Surg Endosc 2010; 24:2842.
  88. Takahashi H, Arimura Y, Masao H, et al. Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc 2010; 72:255.
  89. Yamashina T, Ishihara R, Nagai K, et al. Long-term outcome and metastatic risk after endoscopic resection of superficial esophageal squamous cell carcinoma. Am J Gastroenterol 2013; 108:544.
  90. Saligram S, Chennat J, Hu H, et al. Endotherapy for superficial adenocarcinoma of the esophagus: an American experience. Gastrointest Endosc 2013; 77:872.
  91. Yamada M, Oda I, Nonaka S, et al. Long-term outcome of endoscopic resection of superficial adenocarcinoma of the esophagogastric junction. Endoscopy 2013; 45:992.
  92. Nakagawa K, Koike T, Iijima K, et al. Comparison of the long-term outcomes of endoscopic resection for superficial squamous cell carcinoma and adenocarcinoma of the esophagus in Japan. Am J Gastroenterol 2014; 109:348.
  93. Nomura T, Boku N, Ohtsu A, et al. Recurrence after endoscopic mucosal resection for superficial esophageal cancer. Endoscopy 2000; 32:277.
  94. Pech O, Behrens A, May A, et al. Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett's oesophagus. Gut 2008; 57:1200.
  95. Manner H, Pech O, Heldmann Y, et al. Efficacy, safety, and long-term results of endoscopic treatment for early stage adenocarcinoma of the esophagus with low-risk sm1 invasion. Clin Gastroenterol Hepatol 2013; 11:630.
  96. Buttar NS, Wang KK, Lutzke LS, et al. Combined endoscopic mucosal resection and photodynamic therapy for esophageal neoplasia within Barrett's esophagus. Gastrointest Endosc 2001; 54:682.
  97. Nijhawan PK, Wang KK. Endoscopic mucosal resection for lesions with endoscopic features suggestive of malignancy and high-grade dysplasia within Barrett's esophagus. Gastrointest Endosc 2000; 52:328.
  98. Giovannini M, Bories E, Pesenti C, et al. Circumferential endoscopic mucosal resection in Barrett's esophagus with high-grade intraepithelial neoplasia or mucosal cancer. Preliminary results in 21 patients. Endoscopy 2004; 36:782.
  99. Peters FP, Kara MA, Rosmolen WD, et al. Stepwise radical endoscopic resection is effective for complete removal of Barrett's esophagus with early neoplasia: a prospective study. Am J Gastroenterol 2006; 101:1449.
  100. Conio M, Repici A, Cestari R, et al. Endoscopic mucosal resection for high-grade dysplasia and intramucosal carcinoma in Barrett's esophagus: an Italian experience. World J Gastroenterol 2005; 11:6650.
  101. Larghi A, Lightdale CJ, Ross AS, et al. Long-term follow-up of complete Barrett's eradication endoscopic mucosal resection (CBE-EMR) for the treatment of high grade dysplasia and intramucosal carcinoma. Endoscopy 2007; 39:1086.
  102. Lopes CV, Hela M, Pesenti C, et al. Circumferential endoscopic resection of Barrett's esophagus with high-grade dysplasia or early adenocarcinoma. Surg Endosc 2007; 21:820.
  103. Hattori S, Muto M, Ohtsu A, et al. EMR as salvage treatment for patients with locoregional failure of definitive chemoradiotherapy for esophageal cancer. Gastrointest Endosc 2003; 58:65.
  104. Belderbos TD, Leenders M, Moons LM, Siersema PD. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 2014; 46:388.
  105. Kaltenbach T, Friedland S, Maheshwari A, et al. Short- and long-term outcomes of standardized EMR of nonpolypoid (flat and depressed) colorectal lesions > or = 1 cm (with video). Gastrointest Endosc 2007; 65:857.
  106. Meining A, von Delius S, Eames TM, et al. Risk factors for unfavorable outcomes after endoscopic removal of submucosal invasive colorectal tumors. Clin Gastroenterol Hepatol 2011; 9:590.
  107. Park CH, Cheon JH, Kim JO, et al. Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread. Endoscopy 2011; 43:790.
  108. Ikematsu H, Yoda Y, Matsuda T, et al. Long-term outcomes after resection for submucosal invasive colorectal cancers. Gastroenterology 2013; 144:551.
  109. Yoda Y, Ikematsu H, Matsuda T, et al. A large-scale multicenter study of long-term outcomes after endoscopic resection for submucosal invasive colorectal cancer. Endoscopy 2013; 45:718.
  110. May A, Gossner L, Behrens A, et al. A prospective randomized trial of two different endoscopic resection techniques for early stage cancer of the esophagus. Gastrointest Endosc 2003; 58:167.
  111. Tomizawa Y, Iyer PG, Wong Kee Song LM, et al. Safety of endoscopic mucosal resection for Barrett's esophagus. Am J Gastroenterol 2013; 108:1440.
  112. Katada C, Muto M, Manabe T, et al. Esophageal stenosis after endoscopic mucosal resection of superficial esophageal lesions. Gastrointest Endosc 2003; 57:165.
  113. Hashimoto S, Kobayashi M, Takeuchi M, et al. The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest Endosc 2011; 74:1389.
  114. Sato H, Inoue H, Kobayashi Y, et al. Control of severe strictures after circumferential endoscopic submucosal dissection for esophageal carcinoma: oral steroid therapy with balloon dilation or balloon dilation alone. Gastrointest Endosc 2013; 78:250.
  115. Ahmad NA, Kochman ML, Long WB, et al. Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases. Gastrointest Endosc 2002; 55:390.
  116. Okano A, Hajiro K, Takakuwa H, et al. Predictors of bleeding after endoscopic mucosal resection of gastric tumors. Gastrointest Endosc 2003; 57:687.
  117. Koh R, Hirasawa K, Yahara S, et al. Antithrombotic drugs are risk factors for delayed postoperative bleeding after endoscopic submucosal dissection for gastric neoplasms. Gastrointest Endosc 2013; 78:476.
  118. Binmoeller KF, Grimm H, Soehendra N. Endoscopic closure of a perforation using metallic clips after snare excision of a gastric leiomyoma. Gastrointest Endosc 1993; 39:172.
  119. Kim HS, Lee DK, Jeong YS, et al. Successful endoscopic management of a perforated gastric dysplastic lesion after endoscopic mucosal resection. Gastrointest Endosc 2000; 51:613.
  120. Ohta T, Ishihara R, Uedo N, et al. Factors predicting perforation during endoscopic submucosal dissection for gastric cancer. Gastrointest Endosc 2012; 75:1159.
  121. Kiriyama S, Saito Y, Yamamoto S, et al. Comparison of endoscopic submucosal dissection with laparoscopic-assisted colorectal surgery for early-stage colorectal cancer: a retrospective analysis. Endoscopy 2012; 44:1024.
  122. Tamegai Y, Saito Y, Masaki N, et al. Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy 2007; 39:418.
  123. Fujishiro M, Yahagi N, Kakushima N, et al. Successful nonsurgical management of perforation complicating endoscopic submucosal dissection of gastrointestinal epithelial neoplasms. Endoscopy 2006; 38:1001.
  124. Yoshida N, Wakabayashi N, Kanemasa K, et al. Endoscopic submucosal dissection for colorectal tumors: technical difficulties and rate of perforation. Endoscopy 2009; 41:758.
  125. Jung D, Youn YH, Jahng J, et al. Risk of electrocoagulation syndrome after endoscopic submucosal dissection in the colon and rectum. Endoscopy 2013; 45:714.
  126. Lee TH, Hsueh PR, Yeh WC, et al. Low frequency of bacteremia after endoscopic mucosal resection. Gastrointest Endosc 2000; 52:223.