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Nakamura et al. Mini-invasive Surg 2022;6:50 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2022.38

Review Open Access

Endoscopic submucosal dissection for early gastric

adenocarcinoma: basic procedures and
management of complications

Takahiko Nakamura, Noriya Uedo

Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka 541-8567, Japan.
Correspondence to: Dr. Noriya Uedo, Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69,
Otemae, Chuo-ku, Osaka 541-8567, Japan. E-mail: noriya.uedo@gmail.com
How to cite this article: Nakamura T, Uedo N. Endoscopic submucosal dissection for early gastric adenocarcinoma: basic
procedures and management of complications. Mini-invasive Surg 2022;6:50. https://dx.doi.org/10.20517/2574-1225.2022.38
Received: 18 Apr 2022 First Decision: 4 May 2022 Revised: 18 Jul 2022 Accepted: 8 Aug 2022 Published: 1 Sep 2022

Academic Editors: Giulio Belli, Simon Ng, Jean-François Rey Copy Editor: Jia-Xin Zhang Production Editor: Jia-Xin Zhang

Abstract
Mastery of endoscopic submucosal dissection (ESD) requires a deep understanding of not only the technique but
also the preparation, electrosurgical unit, its peripherals, and probable procedural complications. An endoscope
with a water-jet function is suitable for gastric ESD. A transparent attachment on the tip of the endoscope is
necessary. The mucosal preparation is important for proper lesion recognition and precise device movement during
the procedure and to reduce the risk of complications. A needle-type knife allows accurate tissue dissection and is
especially useful for dissecting fibrosis in the submucosa. A partially insulated-type knife prevents current
transmission from the tip of the needle to the deep tissues, thus reducing the risk of unintentional perforation or
bleeding. When using a scissor-type knife, stable device movement is possible and unintended tissue dissection is
minimized. The electrosurgical unit mode must be adjusted according to the different tissue conditions. The basic
techniques for ESD incision and dissection should be mastered, and the appropriate knives, accessories, strategy,
and traction device should be methodically selected by each operator. The main complications of ESD are bleeding
and perforation, which should be treated appropriately when they occur.

Keywords: Endoscopic submucosal dissection, early gastric adenocarcinoma, endoscopic devices, endoscopic
technique, adverse events

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
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