Skip to main content
SpringerLink
Log in

Endoskopische Submukosadissektion

Endoscopic submucosal dissection

  • Schwerpunkt
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Die endoskopische Submukosadissektion (ESD) wurde Ende der 1990er-Jahre in Japan entwickelt. Mittlerweile hat sie sich auch in Europa an zahlreichen Zentren fest etabliert. Sie stellt eine En-bloc-Schleimhautresektionstechnik zur Behandlung von Frühkarzinomen mit einem Durchmesser >1 cm sowie von flächigen Präkanzerosen dar, die mit bisherigen Schlingenresektionstechniken onkologisch oft nur unbefriedigend in mehreren Partikeln oder mit unsicherem lateralem Sicherheitsabstand abgetragen werden konnten. Bei der ESD wird die Läsion nach zirkulärer Markierung und großflächiger Unterspritzung mit einem Sicherheitsabstand von etwa 5 mm umschnitten und nachfolgend im Niveau der Submukosa mit einem 1–3 mm langen Diathermiemesserchen abgelöst. Die Methode stellt erhöhte technische Ansprüche an die Erfahrung des Untersuchers und ist zeitaufwendiger als die Schlingenresektion. In zahlreichen Studien zeigt sich jedoch eine klare Überlegenheit hinsichtlich R0-Resektionsrate und Lokalrezidivrate. In der vorliegenden Arbeit geben wir einen aktuellen Überblick über die ESD im oberen und unteren Gastrointestinaltrakt und zeigen Perspektiven des Verfahrens auf.

Abstract

Endoscopic submucosal dissection (ESD) was developed in Japan but has now also become permanently established in various centers in Europe. ESD is an endoscopic en bloc mucosal resection technique for the treatment of early cancers with a diameter >1 cm and also superficial precancerous lesions, which could only be removed unsatisfactorily in several fragments or with uncertain lateral safety margins using previous loop excision procedures. Using ESD a lesion is excised after circular marking and generous submucosal injection with a safety margin of approximately 5 mm and subsequently resected at the level of the submucosa with a 1-3 mm short diathermic knife. ESD requires high technical skills in interventional endoscopy and is more time-consuming than snare resection techniques. However, numerous studies have shown a clear superiority for ESD with respect to the R0 resection rate and the local recurrence rate. The present article gives a current review of the use of ESD in the upper and lower gastrointestinal tract and demonstrates perspectives of the procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10
Abb. 11
Abb. 12

Literatur

  1. Kantsevoy SV, Adler DG, Conway JD et al (2008) Endoscopic mucosal resection and endoscopic submucosal dissection. Gastrointest Endosc 68:11–18

    Article  PubMed  Google Scholar 

  2. Saito Y, Uraoka T, Matsuda T et al (2007) Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc 66:966–973

    Article  PubMed  Google Scholar 

  3. Endoscopic Classification Review Group (2005) Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 37:570–578

    Article  Google Scholar 

  4. Tanaka S, Terasaki M, Hayashi N et al (2013) Warning for unprincipled colorectal endoscopic submucosal dissection: accurate diagnosis and reasonable treatment strategy. Dig Endosc (im Druck). DOI 10.1111/den.12016

  5. Tanaka S, Terasaki M, Kanao H et al (2012) Current status and future perspectives of endoscopic submucosal dissection for colorectal tumors. Dig Endosc 24(Suppl 1):73–79

    Article  PubMed  Google Scholar 

  6. Lambert R, Tanaka S (2012) Laterally spreading tumors in the colon and rectum. Eur J Gastroenterol Hepatol 24:1123–1134

    Article  PubMed  Google Scholar 

  7. Yoo JH, Shin SJ, Lee KM et al (2012) Risk factors for perforations associated with endoscopic submucosal dissection in gastric lesions: emphasis on perforation type. Surg Endosc 26:2456–2464

    Article  PubMed  Google Scholar 

  8. Nagahama T, Yao K, Maki S et al (2011) Usefulness of magnifying endoscopy with narrow-band imaging for determining the horizontal extent of early gastric cancer when there is an unclear margin by chromoendoscopy (with video). Gastrointest Endosc 74:1259–1267

    Article  PubMed  Google Scholar 

  9. Kudo S, Kashida H, Nakajima T et al (1997) Endoscopic diagnosis and treatment of early colorectal cancer. World J Surg 21:694–701

    Article  PubMed  CAS  Google Scholar 

  10. Kudo S, Tamura S, Nakajima T et al (1996) Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 44:8–14

    Article  PubMed  CAS  Google Scholar 

  11. Oka S, Tanaka S, Hiyama T et al (2004) Clinicopathologic and endoscopic features of colorectal serrated adenoma: differences between polypoid and superficial types. Gastrointest Endosc 59:213–219

    Article  PubMed  Google Scholar 

  12. Hochberger J, Kruse E, Gaertner T et al (2010) Endoskopische Submukosadissektion (ESD) im Ösophagus. Endoskopie heute 23:2–8

    Article  Google Scholar 

  13. Wang WL, Wu ZH, Sun Q et al (2012) Meta-analysis: the use of carbon dioxide insufflation vs. room air insufflation for gastrointestinal endoscopy. Aliment Pharmacol Ther 35:1145–1154

    Article  PubMed  CAS  Google Scholar 

  14. Hochberger J, Kruse E, Wedi E et al (2011) Training in endoscopic mucosal resection and endoscopic submucosal dissection. In: Cohen J (Hrsg) Successful gastrointestinal endoscopy. Wiley-Blackwell, Oxford, UK, S 204–237

  15. Ono S, Fujishiro M, Niimi K et al (2009) Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc 70:860–866

    Article  PubMed  Google Scholar 

  16. Hochberger J, Dammer S, Menke D et al (2010) Technische Aspekte bei der endoskopischen Submucosa-Dissektion (ESD). Endoskopie heute 23:24–33

    Article  Google Scholar 

  17. Hochberger J, Kruse E, Wedi E et al (2011) Neue Instrumente für die endoskopische Submukosadissektion. Gastroenterologe 6:418–426

    Article  Google Scholar 

  18. Hochberger J (2010) Endoscopic submucosal dissection (ESD) – an educational DVD. 1. Aufl. LUX AV Audiovisual Editions, Kassel

  19. Robert Koch-Institut, Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V. (Hrsg) B. Krebs in Deutschland 2007/2008. 8. Ausgabe

  20. Parkin DM, Bray F, Ferlay J et al (2002) Global cancer statistics. CA Cancer J Clin 55:74–108

    Article  Google Scholar 

  21. Sano T, Kobori O, Muto T (1992) Lymph node metastasis from early gastric cancer: endoscopic resection of tumour. Br J Surg 79:241–244

    Article  PubMed  CAS  Google Scholar 

  22. Amano Y, Ishihara S, Amano K et al (1998) An assessment of local curability of endoscopic surgery in early gastric cancer without satisfaction of current therapeutic indications. Endoscopy 30:548–552

    Article  PubMed  CAS  Google Scholar 

  23. Gotoda T, Sasako M, Ono H et al (2001) Evaluation of the necessity for gastrectomy with lymph node dissection for patients with submucosal invasive gastric cancer. Br J Surg 88:444–449

    Article  PubMed  CAS  Google Scholar 

  24. Gotoda T, Yanagisawa A, Sasako M et al (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225

    Article  PubMed  Google Scholar 

  25. Hosokawa K, Yoshida S (1998) Recent advances in endoscopic mucosal resection for early gastric cancer. Gan To Kagaku Ryoho 25:476–483

    PubMed  CAS  Google Scholar 

  26. Ono H, Kondo H, Gotoda T et al (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229

    Article  PubMed  CAS  Google Scholar 

  27. Ohkuwa M, Hosokawa K, Boku N et al (2001) New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife. Endoscopy 33:221–226

    Article  PubMed  CAS  Google Scholar 

  28. Miyamoto S, Muto M, Hamamoto Y et al (2002) A new technique for endoscopic mucosal resection with an insulated-tip electrosurgical knife improves the completeness of resection of intramucosal gastric neoplasms. Gastrointest Endosc 55:576–581

    Article  PubMed  Google Scholar 

  29. Lian J, Chen S, Zhang Y et al (2012) A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc 76:763–770

    Article  PubMed  Google Scholar 

  30. Oda I, Saito D, Tada M et al (2006) A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 9:262–270

    Article  PubMed  Google Scholar 

  31. Probst A, Pommer B, Golger D et al (2010) Endoscopic submucosal dissection in gastric neoplasia – experience from a European center. Endoscopy 42:1037–1044

    Article  PubMed  CAS  Google Scholar 

  32. Association JGC (1998) Japanese classification of gastric carcinoma – second English edition. Gastric Cancer 1:10–24

    Article  Google Scholar 

  33. Schumacher B, Charton JP, Nordmann T et al (2012) Endoscopic submucosal dissection of early gastric neoplasia with a water jet-assisted knife: a Western, single-center experience. Gastrointest Endosc 75:1166–1174

    Article  PubMed  Google Scholar 

  34. Saito Y, Emura F, Matsuda T et al (2005) A new sinker-assisted endoscopic submucosal dissection for colorectal cancer. Gastrointest Endosc 62:297–301

    Article  PubMed  Google Scholar 

  35. Fujishiro M, Yahagi N, Nakamura M et al (2006) Endoscopic submucosal dissection for rectal epithelial neoplasia. Endoscopy 38:493–497

    Article  PubMed  CAS  Google Scholar 

  36. Fujishiro M, Yahagi N, Kakushima N et al (2007) Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol 5:678–683

    Article  PubMed  Google Scholar 

  37. Hurlstone DP, Atkinson R, Sanders DS et al (2007) Achieving R0 resection in the colorectum using endoscopic submucosal dissection. Br J Surg 94:1536–1542

    Article  PubMed  CAS  Google Scholar 

  38. Repici A, Hassan C, De Paula Pessoa D et al (2012) Efficacy and safety of endoscopic submucosal dissection for colorectal neoplasia: a systematic review. Endoscopy 44:137–150

    Article  PubMed  CAS  Google Scholar 

  39. Probst A, Golger D, Arnholdt H et al (2009) Endoscopic submucosal dissection of early cancers, flat adenomas, and submucosal tumors in the gastrointestinal tract. Clin Gastroenterol Hepatol 7:149–155

    Article  PubMed  Google Scholar 

  40. Probst A, Golger D, Anthuber M et al (2012) Endoscopic submucosal dissection in large sessile lesions of the rectosigmoid: learning curve in a European center. Endoscopy 44:660–667

    Article  PubMed  CAS  Google Scholar 

  41. Kruse E, Buerrig KF, Wilhelms G et al (2012) Endoskopische Submucosa Dissektionen (ESD) bei 81 Patienten mit flächigen Polypen im Recto-Sigmoid bis 16 cm Größe. Endoskopie heute 25:FV7 (Abstract)

    Google Scholar 

  42. Titi M, Overhiser A, Ulusarac O et al (2012) Development of subsquamous high-grade dysplasia and adenocarcinoma after successful radiofrequency ablation of Barrett’s esophagus. Gastroenterology 143:564–566.e1

    Article  PubMed  Google Scholar 

  43. Hochberger J, Koehler P, Wedi E et al (2012) Successful mucosal transplantation from stomach to esophagus for stricture prevention after widespread circular endoscopic submucosal dissection (ESD) for early esophageal squamous cell carcinoma – report of a first case in man with 1 year transplant survival after preliminary experiments in the pig. Z Gastroenterol 50:108 (Abstract K261)

    Google Scholar 

  44. Mori H, Rafiq K, Kobara H et al (2012) Local steroid injection into the artificial ulcer created by endoscopic submucosal dissection for gastric cancer: prevention of gastric deformity. Endoscopy 44:641–648

    Article  PubMed  CAS  Google Scholar 

  45. Hanaoka N, Ishihara R, Takeuchi Y et al (2012) Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: a controlled prospective study. Endoscopy 44:1007–1011

    Article  PubMed  CAS  Google Scholar 

  46. Isomoto H, Yamaguchi N, Nakayama T et al (2011) Management of esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. BMC Gastroenterol 11:46

    Article  PubMed  Google Scholar 

  47. Yamaguchi N, Isomoto H, Shikuwa S et al (2011) Effect of oral prednisolone on esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma: a case report. Digestion 83:291–295

    Article  PubMed  Google Scholar 

  48. Yamaguchi N, Isomoto H, Nakayama T et al (2011) Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc 73:1115–1121

    Article  PubMed  Google Scholar 

  49. Wedi E, Menke D, Hochberger J (2012) Der Over-The-Scope-Clip (OTSC) – Erste klinische Erfahrung bei der Behandlung von schweren Blutungen, Perforationen und Fisteln an 40 Patienten. Endoskopie heute 25:FV24 (Abstract)

    Article  Google Scholar 

  50. Zhang XL, Qu JH, Sun G et al (2012) Feasibility study of secure closure of gastric fundus perforation using over-the-scope clips in a dog model. J Gastroenterol Hepatol 27:1200–1204

    Google Scholar 

  51. Renteln D von, Rosch T, Kratt T et al (2012) Endoscopic full-thickness resection of submucosal gastric tumors. Dig Dis Sci 57:1298–1303

    Article  CAS  Google Scholar 

  52. Topazian M, Zhong N, Baron TH et al (2012) Photodynamic therapy of intraductal papillary mucinous neoplasm. Endoscopy 44:213–215

    Article  PubMed  CAS  Google Scholar 

  53. Suhail AH, Marvik R, Halgunset J et al (2012) Efficacy and safety of transgastric closure in natural orifice transluminal endoscopic surgery using the OTSC system and T-bar sutures: a survival study in a porcine model. Surg Endosc 26:2950–2954

    Article  PubMed  Google Scholar 

  54. Yoshida N, Yagi N, Inada Y et al (2012) Possibility of ex vivo animal training model for colorectal endoscopic submucosal dissection. Int J Colorectal Dis 28:49–56

    Article  PubMed  Google Scholar 

  55. Yamamoto Y, Fujisaki J, Ishiyama A et al (2012) Current status of training for endoscopic submucosal dissection for gastric epithelial neoplasm at Cancer Institute Hospital, Japanese Foundation for Cancer Research, a famous Japanese hospital. Dig Endosc 24(Suppl 1):148–153

    Article  PubMed  Google Scholar 

  56. Tanaka S, Morita Y, Fujita T et al (2012) Ex vivo pig training model for esophageal endoscopic submucosal dissection (ESD) for endoscopists with experience in gastric ESD. Surg Endosc 26:1579–1586

    Article  PubMed  Google Scholar 

  57. Ohata K, Ito T, Chiba H et al (2012) Effective training system in colorectal endoscopic submucosal dissection. Dig Endosc 24(Suppl 1):84–89

    Article  PubMed  Google Scholar 

  58. Oda I, Odagaki T, Suzuki H et al (2012) Learning curve for endoscopic submucosal dissection of early gastric cancer based on trainee experience. Dig Endosc 24(Suppl 1):129–132

    Article  PubMed  Google Scholar 

  59. Niimi K, Fujishiro M, Goto O et al (2012) Safety and efficacy of colorectal endoscopic submucosal dissection by the trainee endoscopists. Dig Endosc 24(Suppl 1):154–158

    Article  PubMed  Google Scholar 

  60. Kato M, Gromski M, Jung Y et al (2012) The learning curve for endoscopic submucosal dissection in an established experimental setting. Surg Endosc 27:154–161

    Article  PubMed  Google Scholar 

  61. Tanimoto MA, Torres-Villalobos G, Fujita R et al (2011) Learning curve in a Western training center of the circumferential en bloc esophageal endoscopic submucosal dissection in an in vivo animal model. Diagn Ther Endosc 2011:847831

    Article  PubMed  Google Scholar 

  62. Takahashi T, Ando T, Kabeshima Y et al (2009) Borderline cases between benignancy and malignancy of the duodenum diagnosed successfully by endoscopic submucosal dissection. Scand J Gastroenterol 44:1377–1383

    Article  PubMed  Google Scholar 

  63. Honda T, Yamamoto H, Osawa H et al (2009) Endoscopic submucosal dissection for superficial duodenal neoplasms. Dig Endosc 21:270–274

    Article  PubMed  Google Scholar 

  64. Muguruma N, Okamura S, Imoto Y et al (2012) Hypopharyngeal injury caused by overtube insertion during endoscopic submucosal dissection. Endoscopy 44(Suppl 2) UCTN:E225

    Article  PubMed  Google Scholar 

  65. Iizuka T, Kikuchi D, Hoteya S et al (2011) Clinical advantage of endoscopic submucosal dissection over endoscopic mucosal resection for early mesopharyngeal and hypopharyngeal cancers. Endoscopy 43:839–843

    Article  PubMed  CAS  Google Scholar 

  66. Shimizu Y, Yamamoto J, Kato M et al (2006) Endoscopic submucosal dissection for treatment of early stage hypopharyngeal carcinoma. Gastrointest Endosc 64:255–259 (Diskussion: 260–262)

    Google Scholar 

  67. Inoue H, Minami H, Kobayashi Y et al (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42:265–271

    Article  PubMed  CAS  Google Scholar 

  68. Renteln D von, Inoue H, Minami H et al (2012) Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study. Am J Gastroenterol 107:411–417

    Article  Google Scholar 

  69. Hochberger J, Kruse E, Wedi E et al (2011) Neue Instrumente für die endoskopische Submukosadissektion. Endo-Praxis 27:150–156

    Google Scholar 

  70. Kaltenbach T, Soetikno R (2013) Endoscopic resection of large colon polyps. Gastrointest Endosc Clin N Am 23:137–152

    Article  PubMed  Google Scholar 

  71. Gostout CJ, Knipschield MA (2012) Submucosal endoscopy with mucosal resection: a hybrid endoscopic submucosal dissection in the porcine rectum and distal colon. Gastrointest Endosc 76:829–834

    Article  PubMed  Google Scholar 

  72. Sumiyama K, Tajiri H, Gostout CJ et al (2010) Chemically assisted submucosal injection facilitates endoscopic submucosal dissection of gastric neoplasms. Endoscopy 42:627–632

    Article  PubMed  CAS  Google Scholar 

  73. Sumiyama K, Gostout CJ (2007) Novel techniques and instrumentation for EMR, ESD, and full-thickness endoscopic luminal resection. Gastrointest Endosc Clin N Am 17:471–485, v–vi

    Article  PubMed  Google Scholar 

  74. Uraoka T, Saito Y, Yahagi N (2012) What are the latest developments in colorectal endoscopic submucosal dissection? World J Gastrointest Endosc 4:296–300

    Article  PubMed  Google Scholar 

Download references

Danksagung

Wir danken Herrn Prof. Naoisha Yahagi, Tokyo, und Frau Prof. Hitomi Minami, Nagasaki, und Kollegen für die sorgfältige Prüfung der Paris- und LST-Präparateklassifikation (Abb. 3, 4, 5, 10, 11).

Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: Prof. Hochberger: kein Interessenkonflikt in Hinsicht auf diesen Beitrag. (Sonstige: Ovesco GmbH, Tübingen, AR 2009–2012; Falk Foundation, Freiburg, VT).

Author information

Authors and Affiliations

  1. Sérvice de Gastroentérologie, Hôpitaux Universitaires de Strasbourg – NHC, 1 Place de l’Hôpital, 67000, Strasbourg (Cedex), Frankreich

    J. Hochberger, J. Hûppertz, M. Delvaux, G. Gay & E. Wedi

  2. Institut für Nutztiergenetik, Bundesforschungsinstitut für Tiergesundheit (FLI), Mariensee, Deutschland

    P. Köhler

  3. Medizinische Klinik III – Gastroenterologie, St. Bernward Krankenhaus, Hildesheim, Deutschland

    E. Kruse

Authors
  1. J. Hochberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Köhler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Kruse
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Hûppertz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Delvaux
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Gay
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E. Wedi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Hochberger.

Zusatzmaterial online

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hochberger, J., Köhler, P., Kruse, E. et al. Endoskopische Submukosadissektion. Internist 54, 287–301 (2013). https://doi.org/10.1007/s00108-012-3179-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-012-3179-2

Schlüsselwörter

Keywords

Search

Navigation