INTRODUCTION Endoscopic submucosal dissection (ESD) is a newly developed endoscopic treatment used to obtain a large mucosal specimen in one fragment . It has contributed to the advantages of the treatment of early gastrointestinal cancer. On the other hand, many disadvantages such as difficulty in learning the techniques, the long time required to perform the procedure and complications such as bleeding and perforation must be solved. With the application of the laparoscopic cholecystectomy ( LC ) technique, we have performed 51 cases of ESD with good results. This method, including the operation method of major complication, will be discussed.
METHODS AND PROCEDURES These 51 cases are as follows: 2 esofageal carcinoma, 1 esofageal SMT, 10 gastric adenicarcinoma, 13 gastric adenoma( called ATP ), 4 hyperplastic polyp, 1 gastric SMT, 6 colon cancer, 10 colon adenoma ( called LST ) and 4 rectal carcinoid.
We use an endoscopic Hook knife, which is smaller than a laparoscopic hook knife in LC but similar shape. By using this Hook knife, we could perform ESD under direct vision, which is different from using the IT knife.
RESULTS There were 5 perforation cases, three of which had to undergo open surgery ( Postoperative course were uneventful) . However, there were no bleeding cases.
CONCLUSIONS Some institutions gave up on ESD because of the difficulty and major complications. In the early period, we were able to accomplish ESD without fatal complication using LC technique. There were many simlarities such as identifying the correct layer, dealing with vessels and the endurance of the operator between ESD and LC. Not only the endoscopinist but also the endoscopic surgeron will be suited to perform ESD.
Program Number: P356