Esophageal endoscopic submucosal dissection (ESD) aiming for the safest procedure

Endoscopic submucosal dissection (ESD) developing in the stomach has also been recognized as one of the standard treatments for esophageal neoplasms in Japan. Advantage of ESD is to be controllable in size and shape, and to be resectable even in large and fibrotic neoplasms. The disadvantage is longer procedure time, heavier bleeding, and higher possibility of perforation. Accompanying complications, especially perforation, in the esophageal ESD may result in more life-threatening outcomes than those in the stomach ESD, so the safest way to accomplish successful en bloc resection without complication should be identified. All of the following key points should be at least adequately managed to reach the goal ; 1. preoperative evaluation of the patients, 2. preoperative evaluation of the lesions, 3. preparation of endoscopic equipment and devices, 4. perioperative monitoring and sedation, 5. technical strategy for resection, 6. how to cope with complication, 7. postoperative management. In this technical note, we would like to show how to manage the above points in our departments, aiming for the safest esophageal ESD without any complication.