Published online Jul 16, 2014. doi: 10.4253/wjge.v6.i7.286
Revised: May 28, 2014
Accepted: June 18, 2014
Published online: July 16, 2014
Processing time: 229 Days and 15.4 Hours
Endoscopic submucosal dissection (ESD) has been established as a standard treatment for early stage gastric cancer (EGC) in Japan and has spread worldwide. ESD has been used not only for EGC but also for early esophageal and colonic cancers. However, ESD is associated with several adverse events, such as bleeding and perforation, which requires more skill. Adequate tissue tension and clear visibility of the tissue to be dissected are important for effective and safe dissection. Many ESD methods using traction have been developed, such as clip-with-line method, percutaneous traction method, sinker-assisted method, magnetic anchor method, external forceps method, internal-traction method, double-channel-scope method, outerroute method, double-scope method, endoscopic-surgical-platform, and robot-assisted method. Each method has both advantages and disadvantages. Robotic endoscopy, enabling ESD with a traction method, will become more common due to advances in technology. In the near future, simple, noninvasive, and effective ESD using traction is expected to be developed and become established as a worldwide standard treatment for superficial gastrointestinal neoplasias.
Core tip: Endoscopic submucosal dissection (ESD) is associated with several adverse events, therefore, it requires more skill. Adequate tissue tension and clear visibility of the tissue to be dissected by traction are important for effective and safe ESD like surgery. Many ESD methods with traction have been reported until now. We review these ESD methods not only for early stage gastric cancer but also for early esophageal cancer or colonic cancer. We highlight both advantages and disadvantages of these methods.