WORKSHOP I

Endoscopic Esophageal Mucosal Resection Using Various Methods Tsuneo OYAMA and Akih iko TOGOU Department of Gastroenterology, Saku Central Hospital Endoscopic esophageal mucosal resection (EEMR) is an effective treatment for esophageal superficial cancer. There are three EEMR methods : EEMR-tube, two-channel and endoscopic mucosal resection by the fitted cap method (EMRC). The size of the specimen resected with the EEMRtube method exceeds that of the other methods. However, small resections are difficult with the EEMR-tube method. Furthermore, if the lesion is located in the lower part of the esophagus, causing compression of the right main bronchus, the lesion cannot be clearly visualized and therefore cannot be resected using this method. Precise resection can be carried out with the two-channel method, but the resected specimen can be no more than 20 mm in diameter. This method is thus suitable for second resections in the process of piecemeal resection. The EMRC method is the easiest technique. The resected specimen is not particularly large, but when the lesion is located in the lower part of the esophagus, it can easily be resected by the EMRC method. Thus, we employ the EEMR method on a case by case basis, as follows ; if the lesion is larger than 20 mm, the technique of first choice is the EEMR-tube method because the resected specimen is the largest among the three methods. When the lesion cannot be resected as a whole, piecemeal resection is necessary. At the second resection, extensive resection causes stenosis. Thus, the two-channel method or the EMRC method is useful for the second resection. Furthermore, if the lesion is located in the lower portion of the esophagus, the EMRC method is useful because the lesion can be clearly visualized as the cap compresses the airway and the lesion can thus be resected easily. If the lesion is 20mm or less in diameter, any method can be applied.