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The History of Endoscopic Treatment of the Gastric Cancer―From Polypectomy to ESD Tsuneo Oyama 1 , Yoshinori Miyata 1 1Department of Gastroenterology, Saku Central Hospital Keyword: 胃癌 , EMR , ESD pp.79-83
Published Date 2005/1/25
DOI https://doi.org/10.11477/mf.1403100008
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 Endoscopic resection for gastric cancer was derived from polypectomy in 1968, but only protruded lesions could be resected by the polypectomy method. So a kind of destruction method with laser irradiation was developed to treat flat lesions. The EHRSE method developed by Hirao in 1993 and the strip biopsy (SB) method developed by Tada in 1994 made it possible to resect flat lesions. The SB method became popular because it was easier than ERHSE to use.

 The aspiration methods (EMRC, EAM etc.) were developed in the 1980s and these techniques were called EMR (endoscopic mucosal resection). In the EMR generation, even depressed lesions became resectable. However, the size of resectable lesions was only 15~20 mm and precise resection was impossible. The local recurrence rate of piecemeal-resected cases was higher than that of one-piece-resected lesions. From this, it is obvious that a new method that can cope accurately with larger lesions was desirable.

 Hosokawa developed the IT knife to improve the safety of the needle knife. Oyama developed the Hook knife to resect submucosal fibers directly. Yamamoto used sodium hyaluronate as a submucosal injection medium to keep the lesion elevated longer than saline is able to. After that, Yahagi used fine snare instead of needle knife to improve the safety of the needle knife. Finally, a new endoscopic resection method, endoscopic submucosal dissection (ESD), with end knives was developed. A precise large resection was able to be performed by ESD. One-piece-resection rate was improved by this new technique. However, there remain certain problems, the training system, complications and so on. Endoscopic surgery is challenged to develop a new technique that will enable perfect resection of lesions.


Copyright © 2005, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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