Theoretical and technical requirements to expand EMR indications

A large study of surgically resected gastric cancers revealed several conditions of mucosal cancers without lymph node metastasis, and if we are able to resect such lesions in an en bloc fashion, it would be judged to be a curative treatment. With the use of submucosal dissection method, giant lesions, e.g. over 10 cm that occupy the entire lesser curvature of the stomach, lesions of difficult locations, e.g. the esophago-gastric junction and lesions with submucosal fibrosis caused by ulcer scars, have been treated successfully. These technical progresses have enabled the application of endoscopic mucosal resection to many lesions that meet theoretical conditions.