Concept of ESD and its current status in Japan

Endoscopic submucosal dissection (ESD) was developed in Japan for the en-bloc resection of early gastric cancer. Main advantages of ESD are the possibility of a histo-pathological evaluation of the entire specimen as well as a lower local -recurrence rate compared to piecemeal resec-tion. The article summarizes the concept of ESD and gives the an overview of the indications accept-ed for local treatment of early GI cancers. Technical problems resulting form difficult loca-tions of the lesion are discussed as well as the technical prerequisites and the qualification of the endoscopist. The different steps of the pro-cedure are illustrated on the basis of a gastric ESD.