Endoscopic procedures developed in Japan

Endoscopic submucosal dissection (ESD) was developed as an endoscopic treatment technique for superficial gastrointestinal neoplasia in Japan. After submucosal injection and circumferential incision around the tumor, direct dissection of the submucosa underneath the lesion is performed in this procedure. ESD has the advantage over conventional endoscopic mucosal resection, enabling tumor removal in an en bloc manner and pathological review of the resected one. In this special issue, Gotoda, Sakamoto and Ishihara et al. have outlined the details of gastric, colorectal and esophageal ESD with special reference to Barrett’s cancer, respectively (1-3). ESD requires endoscopic skill and sufficient experience in relation to substantial risks of such complications as bleeding and perforation. Thus, a standardized ESD training system has being established to disseminate safe and effective ESD technique globally, as proposed by Gotoda and Tsuji et al. from both the representative high-volume ESD centers in Japan (2,4). In the near future, we believe global dissemination of this procedure can be a great boon for much more patients suffering from gastrointestinal neoplasia.