Reply to Cipoletta et al.

We have read the letter by Cipoletta et al. suggesting the use of the unified term “endoscopic resection.” We thank the authors for their concern about our previous publication in Endoscopy [1]. In our previous report, we applied the term “endoscopic submucosal dissection (ESD)” to our method. Recently, the term ESD has been used frequently and internationally [1] [2] [3]; the term “mucosectomy” had been previously used [4]. The term ESD was used to describe a specific type of endoscopic mucosal resection (EMR) because it was thought to be an improved technique of EMR [5]. The proliferation of different definitions has generated some confusion, as Cipoletta et al. have indicated. However, we think the introduction of ESD has been the main cause of this confusion. In addition, there is a significant difference in the rate of en bloc resection between the two methods, which may affect the accuracy of the histological diagnosis. In Japan, the term ESD is already commonly used by our professional and academic institutions [1] [2].

As Cipoletta et al. have noted, endoscopic polypectomy, EMR, endoscopic mucosectomy, and ESD are the same technique in terms of resecting mucosa and submucosa. In the analogy to surgery, these methods can be unified under the special term of “endoscopic resection.” We think that the unified term should be considered for the technique to dissect submucosa by special dissecting devices. However, we think that this new term might not be used easily; if new terms are suggested by many endoscopists, more rather than less confusion will be generated. We hope that the term “endoscopic resection” and its definition will be discussed at international conferences in the near future.

Competing interests: None

References

• 1 Yoshida N, Wakabayashi N, Kanemasa K. et al . Endoscopic submucosal dissection for colorectal tumors: technical difficulties and rate of perforation.  Endoscopy. 2009;  41 758-761
• 2 Tanaka S, Oka S, Chayama K. Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection.  J Gastroenterol. 2008;  43 641-651
• 3 Cao Y, Liao C, Tan A. et al . Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract.  Endoscopy. 2009;  41 751-757
• 4 Yamamoto H, Yahagi N, Oyama T. Mucosectomy in the colon with endoscopic submucosal dissection.  Endoscopy. 2005;  37 764-768
• 5 Yamamoto H, Koiwai H, Yube T. et al . A successful single-step endoscopic resection of a 40 millimeter flat-elevated tumor in the rectum: endoscopic mucosal resection using sodium hyaluronate.  Gastrointest Endosc. 1999;  50 701-704