DIFFERENCES IN ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) PERFORMED IN JAPAN AND THE UNITED STATES -BASED ON THE EXPERIENCE OF ESD IN JAPAN AND THE US-

Abstract

It is well known that there have been gaps in the pathological diagnosis and definition of endoscopic findings between Japan and the US. Specifically the difference in the pathological definition of intraepithelial neoplasm is well known. In Japan, gastrointestinal epithelial neoplasm tends to be diagnosed and removed focally, while in the US, it tends to be recognized as a premalignant field defect and is treated in the field. These differences may be due to differences in surveying technique where targeted biopsy tends to be performed in Japan while random biopsy tends to be performed in the US. In Japan, endoscopic submucosal dissection (ESD) has been performed to treat esophageal squamous cell carcinoma, gastric cancer associated with H. pylori infection, and colorectal lesions. On the other hand, in the US, ESD is performed to treat Barrettʼs adenocarcinoma, gastric cancer without H. pylori infection, and hereditary colorectal neoplasm. Other differences include sedation techniques, performing advanced procedures on an inpatient verses outpatient basis and overall health care delivery. As globalization progresses, we should continue to share endoscopic knowledge and resection techniques across the world.