Tsuneo Oyama - Endoscopic Diagnosis of Esophageal Carcinoma for ESD

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We, at Saku Central Hospital Division of Endoscopy, use magnifying endoscopy for all of our endoscopic evaluations. It is our routine practice to perform white light imaging, followed by NBI observation, and finally with magnifying NBI to consider histological structures. Our diagnoses are based on endoscopic findings, confirmed by biopsies. And our endoscopists themselves review all the biopsy microslides, and all of the histological findings are compared with the endoscopic images.

Markings for ESD are routinely performed with magnifying endoscopes. And, immediately following each ESD, the resected specimen is spread, pinned, and examined under the stereotypic microscope for image documentations. Furthermore, the resected specimen is observed with magnifying NBI to determine how to slice the specimen for histological evaluation. After formalin fixation of the specimen, each endoscopist who has performed ESD must slice the fixed specimen for microslides, make histological diagnosis of the prepared microslides, and prepare histological mapping of the fixed specimen. At our ESD conferences, preoperative diagnoses are evaluated with utmost scrutiny for accuracy, based on comparative evaluations of pre-ESD endoscopic images, post-ESD stereotypic microscope images, and histological images of the resected lesion.

Based on our prior experiences, we published in 2010 the Japanese edition ofEndoscopic Diagnosis of Superficial Gastric Cancer for ESD, which to date has undergone fourth printing, and was translated and published in Chinese and English editions as well. English publications (related to GI endoscopy) are many but often coming short in endoscopic image quality, likely due to the fact that endoscopes are generally considered as tools for obtaining biopsies, not as tools for making diagnoses in many countries. We are indeed pleased that our English edition ofEndoscopic Diagnosis of Superficial Gastric Cancer for ESD, utilizing high-quality endoscopic images and explaining relationships between the magnified endoscopic images and the histological images, is well accepted internationally. Early diagnosis of esophageal cancer is difficult, representing one of the more difficult cancers to treat. But superficial esophageal cancer cases are increasingly diagnosed in recent years. The classification of esophageal cancer introduced in 2014 and published in 2017 by the Japan Esophageal Society had significantly improved magnified endoscopic diagnoses of esophageal squamous cell cancer cases. And yet, it remains difficult to perform accurate endoscopic diagnoses of invasion depths of esophageal cancers.

We have come to publish this timeEndoscopic Diagnosis of Esophageal Cancer for ESD. The contributing authors are all former trainees of the Department of Gastroenterology of Saku Central Hospital and the newly formed Division of Endoscopy at Saku Medical Center, who all have come to study together in the Oyama school and graduated. This textbook shows the results of their continuing efforts in practicing what they have learned in the Oyama school, studying each precious cases.

Saku Central Hospital was divided and relocated, creating the new Division of Endoscopy at Saku Central Hospital Advanced Care Center consisting of Drs. Akiko Takahashi, Nobukazu Yorimitsu, and myself. With only three of us, we are now performing over 300 ESD and LECS cases yearly, as well as histological preparations, diagnosis, and mapping. Our skills have inevitably been sharpened and improved. In closing this preface, I thank my two colleagues for their efforts in preparation of this publication while maintaining the rigorous daily clinical duties.

May 20, 2017, prior to the 71st Japan Esophageal Society annual meeting in Saku.