Endoscopic submucosal dissection (two-point fixed ESD) for early esophageal cancer.

Background: We have been attempting to improve the safety, reliability and simplicity of endoscopic submucosal dissection for the treatment of early esophageal cancer and to shorten the time needed for this operation.

Methods: The present study involved nine patients with well-differentiated intramucosal early esophageal cancer over 20 mm in diameter. Two-point fixed endoscopic submucosal dissection was carried out.

Results: In all nine cases, the mucosal area to be dissected was successfully identified and kept under direct vision, allowing two-point fixation of the mucosa with forceps and the hood during adequate counter-traction. In this way, the respiration-caused movement of submucosal tissue between the two fixing points was suppressed almost completely. Hemostasis and manipulation on blood vessels were easy with this procedure and dissection could be completed safely, without causing perforation.

Conclusion: Endoscopic submucosal dissection with a transparent hood fitted with a mucosa-holding forceps channel is highly useful, safe and simple when applied to the esophagus.