Endoscopy 2004; 36(11): 1013-1018
DOI: 10.1055/s-2004-814501
Innovation Forum
© Georg Thieme Verlag Stuttgart · New York

Four-Step Endoscopic Esophageal Mucosal Resection (EEMR) Tube Method of Resection for Early Esophageal Cancer

H.  Makuuchi1 , T.  Yoshida2 , C.  Ell3
  • 1Dept. of Surgery, Tokai University School of Medicine, Kanagawa, Japan
  • 2Dept. of Gastroenterology, Showa University/Northern Yokohama Hospital School of Medicine, Yokohama, Japan
  • 3Dept. of Medicine II, Wiesbaden Hospital, Wiesbaden, Germany
Further Information

Publication History

Publication Date:
02 November 2004 (online)

Objectives

Remarkable advances in endoscopic diagnosis have been made with the increasingly widespread use of high-resolution video endoscopy and chromoendoscopy. Clinicians are detecting increasing numbers of early and superficial malignant lesions not only in the stomach and intestines, but also in the esophagus. The same trend can be seen in adenocarcinoma detected in Barrett’s esophagus.

The standard curative surgical approach to esophageal cancer has been thoracotomy and laparotomy with extensive lymph-node dissection - an extremely invasive procedure that has a significant negative effect on the patient’s postoperative quality of life. As a result, there has been a growing need to develop a less invasive surgical therapeutic approach to early esophageal cancer without lymph-node metastasis.

The endoscopic mucosal resection (EMR) method for mucosal esophageal carcinoma was first developed in Japan in 1988 [1] [2]. The strip biopsy method, the endoscopic esophageal mucosal resection (EEMR) tube method [2], and the endoscopic mucosal resection cap (EMRC) method [3] developed rapidly and quickly came into widespread use [4] [5]. Recently, the hook-knife method [6] has been used to achieve incision and ablation of malignant lesions in one piece. We have also developed a four-step EEMR tube method that allows safe, easy, and reliable resection of the lesion [7]. This four-step method of EMR for early esophageal cancer is described here in detail.

References

  • 1 Makuuchi H, Machimura T, Sugihara T. et al . Endoscopic diagnosis and treatment of mucosal carcinoma of the esophagus [in Japanese with English abstract].  Endosc Dig. 1990;  2 447-452
  • 2 Makuuchi H. Endoscopic mucosal resection for early esophageal cancer: indications and techniques.  Dig Endosc. 1996;  8 175-179
  • 3 Inoue H, Endo M. Endoscopic esophageal mucosal resection using a transparent tube.  Surg Endosc. 1990;  4 189-201
  • 4 Lambert R. Endoscopic treatment of esophagogastric tumors.  Endoscopy. 1998;  30 80-93
  • 5 Shim C S. Endoscopic mucosal resection: an overview of the value of different techniques.  Endoscopy. 2001;  33 271-275
  • 6 Oyama T, Kikuchi Y, Tomori A. et al . Endoscopic mucosal resection using hooking knife (hooking EMR) for esophageal early cancer [in Japanese with English abstract].  Clin Gastroenterol. 2001;  16 1609-1615
  • 7 Makuuchi H. Endoscopic mucosal resection for mucosal cancer in the esophagus.  Gastrointest Endosc Clin N Am. 2001;  11 445-450
  • 8 Makuuchi H, Shimada H, Chino O. et al . Possibility of endoscopic mucosal resection in patients with m3 and sm1 [in Japanese with English abstract].  Stomach Intest. 1998;  33 993-1002
  • 9 Makuuchi H, Shimada H, Chino O. et al . Long-term prognosis of m3, sm1 cancer of the esophagus: comparison between EMR and radical surgery cases [in Japanese with English abstract].  Stomach Intest. 2002;  37 53-63
  • 10 Inoue H, Tani M, Nagai K. et al . Treatment of esophageal and gastric tumors.  Endoscopy. 1999;  31 47-55
  • 11 Inoue H. Treatment of esophageal and gastric tumors.  Endoscopy. 2001;  33 119-125
  • 12 Lambert R. Treatment of esophagogastric tumors.  Endoscopy. 2003;  35 118-126

H. Makuuchi, M. D.

Dept. of Surgery · Tokai University School of Medicine

Boseidai, Isehara · Kanagawa 259-1193 · Japan

Fax: + 81-463-932659

Email: makuuchi@is.icc.u-tokai.ac.jp