2018/2019
Gonçalo Viei a Figuei ôa Gomes
Poo ou comes a e gas ic Endoscopic Submucosal Dissec ion: a sys ema ic
e iew and me a-analysis on p edic i e ac o s
Resul ados des a o á eis após disseção endoscópica da submucosa gás ica:
e isão sis emá ica e me a-análise
ma ço, 2019
Mes ado In eg ado em Medicina
Á ea: Gas en e ologia
Tipologia: Disse ação
T abalho e e uado sob a O ien ação de:
D . Diogo Miguel Pe ei a Libânio Mon ei o
E sob a Coo ien ação de:
P o esso Dou o Má io Jo ge Dinis Ribei o
T abalho o ganizado de aco do com as no mas da e is a:
Diges i e Endoscopy
Gonçalo Viei a Figuei ôa Gomes
Poo ou comes a e gas ic Endoscopic Submucosal Dissec ion: a sys ema ic
e iew and me a-analysis on p edic i e ac o s
Resul ados des a o á eis após disseção endoscópica da submucosa gás ica:
e isão sis emá ica e me a-análise
ma ço, 2019
Poo ou comes a e gas ic Endoscopic Submucosal Dissec ion: a
sys ema ic e iew and me a-analysis on p edic i e ac o s
Gonçalo Figuei ôa1, Ped o Pimen el-Nunes MD PhD1,2, Má io Dinis-Ribei o MD PhD1,2, Diogo
Libânio MD1,2
1 MEDCIDS – Depa amen o de Medicina da Comunidade, In o mação e Decisão em Saúde,
Po o, Po ugal
2 Gas oen e ology Depa men , Ins i u o Po uguês de Oncologia do Po o, Po o, Po ugal
Co esponding au ho :
Gonçalo Figuei ôa
Depa amen o de Medicina da Comunidade, In o mação e Decisão em Saúde (MEDCIDS)
Faculdade de Medicina da Uni e sidade do Po o
Rua Dou o Plácido da Cos a
4200-450 Po o, Po ugal
Phone: +351 969 925 733
E-mail: g. iguei [email protected]

ABSTRACT
BACKGROUND AND AIMs: Endoscopic submucosal dissec ion (ESD) is now es ablished as he
i s op ion o manage ea ly gas ic neoplasms bu i s e icacy may a y acco ding o di e se
ac o s. We aimed o sys ema ically iden i y a iables p edic i e o poo ou comes o gas ic ESD.
METHODS: Th ee online da abases (MEDLINE, ISI Web o Knowledge and Scopus) we e
sea ched (las sea ch on June 2018) o poo ou comes o gas ic ESD (deep submucosal
in asion, piecemeal/incomple e esec ion, non-cu a i e esec ion, local ecu ence and
me ach onous lesions).
RESULTS: One hund ed and ou een s udies we e included e e ing o 55.986 ESDs.
Undi e en ia ed his ology and uppe loca ion ( s lowe ) we e ound o be associa ed o
submucosal in asion (OR=2.42 [95%CI 1.62-3.61] and OR=3.20 [1.04-9.86], espec i ely) and
deep submucosal in asion (OR=2.98 [2.02-4.39] and OR=2.35 [1.45-3.81], espec i ely). Lesion
size >30mm and ulce a ion we e associa ed wi h piecemeal esec ion (OR=2.78 [1.17-6.60] and
OR=2.76 [1.23, 6.20]). Lesion size >30mm, ulce a ion, uppe loca ion and ib osis we e isk
ac o s o incomple e esec ion (OR=3.83 [2.68-5.49], OR=4.06 [1.62-10.16], OR=3.71 [2.49-
5.54] and OR=4.46 [1.66-11.96]), espec i ely). A non-cu a i e esec ion was mo e o en
obse ed o lesions wi h uppe loca ion (OR=1.49 [1.24-1.79]), dep essed mo phology (OR=1.49
[1.04-2.12]) and hose ou side s anda d c i e ia (OR=3.56 [2.31-5.48]). Olde age was signi ican ly
linked wi h local ecu ence a es (OR=3.08 [1.13-5.02]) and me ach onous lesions (OR=3.00
[1.77-4.22]).
CONCLUSIONS: Se e al isk ac o s in luence poo e icacy ou comes o gas ic ESD ha may
be used o in o m bo h pa ien s and heal h p o ide s abou he expec ed e icacy.
Key wo ds: Endoscopic submucosal dissec ion, gas ic cance , ou comes, isk ac o s.
In oduc ion
Ea ly gas ic neoplasms wi h null o minimal isk o lymph node me as asis (LNM) can be
e ec i ely ea ed by gas ic endoscopic submucosal dissec ion (ESD). Endoscopic esec ion (by
Endoscopic Mucosal Resec ion o ESD) is ecommended as he s anda d ea men o
di e en ia ed adenoca cinoma <2cm clinically diagnosed as in amucosal (T1a); lesions wi h low
isk o LNM bu ou side hese c i e ia can also be ea ed wi h ESD as an al e na i e o su ge y,
al hough i is s ill conside ed as an in es iga ional ea men in Japanese guidelines[1]. Recen
Eu opean guidelines ecommend endoscopic esec ion as he i s line ea men o gas ic
supe icial neoplas ic lesions wi h e y low isk o LNM, being ESD ecommended as he
ea men o choice[2].
Since he in oduc ion o ESD, se e al s udies e alua ed i s e icacy and sa e y in he
ea men o ea ly gas ic neoplasms [3-6]. A e e icacy and sa e y is p o en and a echnology
becomes accep ed and widely pe o med, esea ch should aim o p edic and op imize ou comes,
in o de o imp o e pa ien selec ion o he echnique and also o imp o e pa ien in o ma ion
abou expec ed ou comes [7-9].
ESD achie es en-bloc/R0 esec ions in mo e han 90% o he cases [10]. Lesions sui able
o endoscopic ea men a e selec ed based on he endoscopic e alua ion wi h
ch omoendoscopy (endoscopic ul asound does no imp o e p edic ion o submucosal in asion
and he e o e is no ou inely ecommended) [2]. Howe e , ESD is no cu a i e in nea ly 20% o
he cases because his opa hological e alua ion shows p e iously unsuspec ed submucosal
in asion o lympho ascula in asion (among o he c i e ia)[11]. Thus, e alua ion o isk ac o s
o submucosal in asion is impo an in o de o imp o e pa ien selec ion o ESD. Since en-bloc
esec ion and R0 esec ion a e equisi es o cu a i e esec ion, i is also impo an o analyze isk
ac o s o piecemeal and R1 ha could possibly help in he selec ion o p ocedu al modi ica ions
o pe haps e e al o expe cen e s [12-14].
ESD is associa ed wi h low local ecu ence a es (1-3%) bu wi h a high isk o me ach onous
lesions on long- e m ollow-up which makes endoscopic su eillance necessa y [11, 15, 16].
Se e al s udies also assessed isk ac o s o hese long- e m ou comes, al hough esul s a e
o en con o e sial. The iden i ica ion o isk ac o s o ecu ence and me ach onous could
he e o e in luence su eillance schedule.
In summa y, se e al pa ien - and lesion-speci ic ac o s ha e been ound o in luence bo h
sho - and long- e m ou comes, bu he e is no consensus ega ding which ac o s a e ac ually
signi ican .
The aim o his s udy was o assess isk ac o s (clinical o endoscopic a iables, a ailable a
he p e- esec ion s age) o poo e icacy ou comes o gas ic ESD, bo h sho - e m (submucosal
in asion, piecemeal and incomple e esec ion, non-cu a i e esec ion) and long- e m (local
ecu ence and me ach onous lesions).
Me hods
a) S udy selec ion
A sys ema ic e iew o he li e a u e was conduc ed in h ee elec onic da abases (MEDLINE
h ough Pubmed), ISI Web o Knowledge and Scopus om incep ion un il 26 h June 2018. The
ollowing sea ch que y wi hou language es ic ion was used in Pubmed: ([gas ic OR s omach]
AND [“endoscopic submucosal dissec ion” OR “ESD”]) AND (non-cu a i e OR “non cu a i e” OR
“submucosal in asion” OR “ ea men ailu e” OR “p ocedu e ailu e” OR “ ecu ence”), wi h he
sea ch que y o o he da abases being adap ed om his que y.
The e e ences o included s udies and e ie ed a icles we e uploaded o Co idence online
pla o m (www.co idence.o g) ha was used o a icles selec ion. Bo h i le and abs ac
sc eening ( o exclusion o i ele an a icles) and ull ex sc eening we e made by wo
independen in es iga o s (GF, DL), being con lic s sol ed by consensus. The ollowing inclusion
Discussion
This sys ema ic e iew and me a-analysis is, o ou knowledge, he i s ha e alua ed p e-
esec ion isk ac o s o poo ou comes o gas ic ESD (deep submucosal in asion, non-cu a i e
esec ion, piecemeal/incomple e esec ion, local ecu ence and me ach onous lesions). ESD is
gaining wo ldwide accep ance as he i s line ea men o gas ic supe icial neoplasms,
al hough i is unsuccess ul in nea ly 20% o he cases [11]. Iden i ica ion o p e- esec ion isk
ac o s o poo e e icacy ou comes o gas ic ESD is hus impo an in o de o e ine pa ien
selec ion o his echnique and also o be e in o m pa ien s abou he success p obabili y o
endoscopic ea men , gi en ha su gical esec ion can also be conside ed when he isk o poo
ou comes is signi ican . We p e iously e alua ed isk ac o s which po en ially in luenced sa e y
o esec ion, bu da a was con o e sial ega ding he p edic o s o poo e ec i eness o gas ic
ESD [7] [8] [3] [4].
We ound ha an undi e en ia ed his ology is a signi ican isk ac o o submucosal in asion
and deep submucosal in asion, which is p obably explained by he p edominan ly in il a i e
g ow h pa e n o undi e en ia ed lesions [21]. Conce ning loca ion, p oximal lesions seem o
ha e a highe p opensi y o ha bo ing submucosal in asion. While he biological explana ion
emains unknown, possibly uppe lesions a e mo e p one o be missed a endoscopy and a e
de ec ed la e .
G ea e lesion size and ulce a ion we e associa ed wi h incomple e/piecemeal esec ion,
likely gi en o echnical p ocedu al di icul ies. Fu he mo e, an uppe loca ion also inc eases he
isk o IR which is p obably ela ed wi h he mo e challenging dissec ion in e o lexed posi ion. A
highe deg ee o ib osis was also iden i ied as being associa ed wi h highe IR a es, and can
also di icul esec ion gi en ha he iden i ica ion o he esec ion ield may be impai ed.
Expanded Endoscopic Indica ion was ound o be associa ed wi h PR/IR, which is in line wi h a
p e ious me a-analysis[22]. Finally, an undi e en ia ed his ology was associa ed wi h IR, which

is p obably ela ed wi h di icul ies in iden i ying lesion ma gins e en using ch omoendoscopy and
also wi h deepe in il a ion which may di icul achie ing a ee e ical ma gin.
Lesions cha ac e is ics, namely g ea e size, uppe loca ion, dep essed mo phology and
ulce a ion we e signi ican ly associa ed wi h non-cu a i e esec ion. Fu he mo e, EGCs ou side
s anda d c i e ia we e also ound o be associa ed wi h NCR, which suppo s he impo ance o
his classi ica ion. An age o e 75 yea s, con as ing wi h o he cu -o s also e alua ed, was
iden i ied as a signi ican isk ac o , which is p obably ela ed o he p e e ence o minimally
in asi e ea men like ESD in olde pa ien s e en when he p obabili y o NCR is highe .
Age is consis en ly epo ed as a isk ac o o LR and ML and was ound o be a signi ican
isk ac o in ou s udy. This inding can ha e implica ions in su eillance schedule, gi en ha
acco ding o his da a i is di icul o de ine an age cu -o when esec ion is no longe o bene i
(con as ing wi h colo ec al cance and pos -polypec omy su eillance). O he signi ican isk
ac o s, such as an uppe loca ion, an undi e en ia ed his ology and BEC lesions we e linked o
he occu ence o LR. We acknowledge ha incomple e esec ion is also he mos impo an isk
ac o o LR; howe e , he aim o his sys ema ic e iew was o iden i y p e- esec ion a iables
associa ed wi h his ou come, and so he signi icance o incomple e esec ion on LR was no
e alua ed in his s udy al hough i was e alua ed in a p e ious me a-analysis by ou g oup [23].
On he o he hand, ML was signi ican ly associa ed wi h he p esence o mul iple lesions, mos
likely due o he p esence o a ield de ec and mic osa elli e ins abili y [24].
In summa y, a p oximal loca ion is a isk ac o o SI, DSI, IR, LR and NCR. Undi e en ia ed
his ology is a isk ac o o SI, DSI, IR, and LR, ulce a ion o PR, IR and NCR, Expanded
Endoscopic Indica ion o PR and IR and Expanded Endoscopic C i e ia o NCR and LR. Finally,
age is a isk ac o o NCR, LR and ML and g ea e lesion size o PR, IR and NCR.
The p ima y limi a ion ha we acknowledge in ou s udy is he occasional sca ci y o s udies
o some isk ac o s. As such, some o he conclusions he e d awn may be unde powe ed, gi en
ha i hinde s he de ec ion o possible in e ac ions and con ounding be ween isk ac o s.
Ne e heless, we conside ha ou esul s a e aluable and a e a s ep o wa d in enabling
endoscopis s in be e selec ing pa ien s ha should be submi ed ESD.
In conclusion, his s udy iden i ies a se o p e- esec ion isk ac o s which signi ican ly
in luence se e al poo e icacy ou comes, bo h sho - and long- e m, ela ed o he esec ion o
gas ic EGCs using ESD. We belie e ha he conclusions he e d awn can be use ul in guiding
gas oen e ologis s when selec ing pa ien s ha should unde go ESD and be e de ining he
p ognosis o such esec ion.
Figu e 1 – Flowcha o included s udies.
Figu e 2 – Fo es plo o Piecemeal esec ion a e acco ding o he p esence/absence o
ulce a ion.
Figu e 3 – Fo es plo o Incomple e esec ion a e acco ding o size (20mm as cu -o ).
Figu e 4 – Fo es plo o Non-cu a i e esec ion a e acco ding o localiza ion (uppe s lowe ).
Tables
Table 1 – Gene al cha ac e is ics o included s udies.
Pe iod
n1 (n2)
Ou come(s) e alua ed
Risk ac o s e alua ed
Quali y
MA
P ospec i e s udies
Japan
Hi a a K, 2013 [25]
2008-2010
65 (65)
ML
Mul iple
8
Yes
Semba S, 2008 [26]
-
73 ( - )
ML
Single (Claudin exp ession)
8
No
Hasuo T, 2007 [27]
2000-2004
110 (110)
ML
Single (Mic osa elli e Ins abili y S a us)
7
No
Yagi K, 2014 [28]
2010-2013
- (197)
SI
Mul iple
7
Yes
Takenaka R, 2008 [29]
2001-2005
275 (306)
PR, IR, LR
Mul iple
7
Yes
China
Shi H, 2017 [30]
2013-2014
32 (32)
LR
Single (Mic oRNA-499 s3746444 A/G
polymo phism)
7
No
Yu K, 2017 [31]
2013-2014
45 (45)
LR
Single (miR-34b s4938723 Polymo phism)
8
No
Li H, 2012 [32]
2009-2011
146 (164)
DSI
Single (ME-NBI image ype)
7
No
Xue H, 2016 [33]
2013-2015
230 ( - )
LR
Single (CD44 exp ession)
6
No
Fu QY, 2016 [34]
2009-2015
242 (242)
SI, DSI
Single (La e al Ma gin Posi i i y)
8
No
Ko ea
Ok KS, 2016 [35]
2012-2014
160 (160)
SI
Mul iple
7
No
Choi IJ, 2016 [18]
2010-2011
712 (737)
SI, NCR
Mul iple
9
Yes
Eu ope
P obs A, 2017 [36]
2005-2016
179 (191)
SI, DSI, PR, IR, NCR
Single (Endocopic C i e ia)
9
No
Re ospec i e s udies
Japan
Nagami Y, 2014 [37]
2007-2011
43 (43)
SI, PR, IR, NCR
Single (His ology)
8
No
Omae, 2013 [38]
2004-2010
44 (44)
SI, NCR
Mul iple
7
Yes
Nishide N, 2012 [39]
2002-2009
59 (62)
PR, IR
Mul iple
7
Yes
Yonezawa J, 2006 [40]
2004-2005
60 (60)
PR, NCR, LR
Single (R-scope ESD)
8
No
Ojima T, 2016 [41]
2002-2013
85 (85)
LR
Mul iple
7
No
Oka S, 2014 [42]
2002-2011
97 (97)
SI, DSI, IR, NCR
Single (His ology)
8
No
Kanemis u T, 2014 [43]
2006-2011
- (105)
SI
Mul iple
8
No
Komo i K, 2016 [44]
2002-2012
107 (124)
PR, IR
Single (Age)
9
Yes
Hi asaki S, 2007 [45]
2002-2006
112 (112)
SI, PR, IR
Single (Size)
8
Yes
Naka a B, 2016 [46]
2007-2016
123 (140)
PR, NCR
Single (Endocopic Indica ion)
8
Yes
Yamada T, 2014 [47]
2007-2012
132 (143)
SI
Single (Submucosal and lympho ascula
in asions)
8
No
Sugimo o T, 2015 [48]
2000-2009
155 ( - )
ML
Mul iple
8
Yes
Ho iguchi N, 2016 [49]
2007-2015
164 (182)
SI, DSI
Single (Helicobac e pylo i E adica ion)
8
Yes
Kakushima N, 2007 [50]
2000-2004
165 (184)
IR
Single (Age)
7
Yes
Sanomu a Y, 2012 [51]
1994-2009
173 (173)
DSI, PR, IR
Mul iple
8
No
Nakamo o S, 2009 [52]
1999-2007
177 (202)
PR, IR
Single (Size)
7
No
Oka S, 2006 [53]
2002-2004
185 (195)
PR, IR, LR
Mul iple
7
Yes
Imagawa A, 2006 [54]
2002-2005
185 (196)
PR, IR
Mul iple
7
Yes
Ka sube T, 2015 [55]
2003-2013
231 ( - )
SI, DSI, PR, NCR
Mul iple
8
Yes
Go o O, 2009 [56]
2000-2007
231 (276)
SI, PR, IR
Single (Submucosal In asion)
8
Yes
Ho iuchi Y, 2018 [57]
2005-2017
264 (268)
NCR
Mul iple
8
Yes
Takenaka R, 2006 [58]
2001-2005
269 (-)
LR
Mul iple
6
No
Oda I, 2006 [59]
2001
- (303)
PR, NCR
Mul iple
7
Yes
Yoshida M, 2016 [60]
2009-2014
307 (334)
PR, IR
Single (Lea ning Cu e Phases)
6
No
Boda T, 2014 [61]
2002-2010
357 (357)
ML
Mul iple
8
No
Oha a Y, 2016 [62]
2008-2012
363 (398)
NCR
Mul iple
8
Yes
Sugimo o T, 2012 [63]
2006-2010
418 (485)
PR
Mul iple
9
Yes
Kosaka T, 2014 [64]
2002-2007
438 ( - )
PR, NCR, LR, ML
Mul iple
8
Yes
Ohni a K, 2009 [65]
2003-2008
468 (495)
SI, PR, NCR
Mul iple
8
Yes
Toyokawa T, 2011 [66]
2003-2009
514 (586)
PR, NCR
Sinlge (Age)
9
Yes
Ojima T, 2016 [67]
2002-2013
532 (583)
SI, PR, IR
Single (Remnan )
8
Yes
Go o, 2013 [68]
2006-2011
533 (605)
SI, DSI, IR, NCR
Mul iple
8
Yes
Isomo o H, 2009 [69]
2001-2007
551 (589)
SI, PR, NCR, LR, ML
Mul iple
8
Yes
Yamaguchi N, 2009 [70]
2001-2007
551 (589)
SI, DSI, PR, IR, NCR
Single (Endoscopic C i e ia)
8
No
Isomo o H, 2010 [71]
2001-2007
661 (713)
SI, DSI, PR, IR, NCR
Single (Age)
8
Yes
Nagahama T, 2017 [72]
2006-2012
704 (863)
DSI
Mul iple
7
Yes
Hi asawa K, 2011 [73]
2000-2010
784 (961)
PR, IR, NCR
Mul iple
8
No
Ho eya S, 2011 [74]
2003-2009
818 (977)
SI, DSI, IR, NCR
Mul iple
7
Yes
Numa a N, 2015 [75]
2005-2011
890 (1053)
IR
Mul iple
7
Yes
Higashimaya M, 2013 [76]
2005-2011
891 (1027)
IR
Mul iple
8
Yes
Oda I, 2005 [77]
2000-2003
945 (1033)
PR, IR, NCR
Mul iple
7
Yes
Toyokawa T, 2012 [20]
2003-2010
967 (1123)
SI, NCR
Mul iple
9
Yes
Maeha a Y, 2017 [78]
2003-2014
1053 ( - )
SI, ML
Single (Helicobac e pylo i E adica ion)
8
Yes
Nakamu a K, 2015 [79]
2002-2011
1161 (1332)
SI, PR, IR
Single (Endocopic C i e ia)
8
No
Ho eya S, 2013 [80]
2005-2010
1224 (1463)
IR, NCR
Single (Loca ion)
8
No
Abe S, 2015 [81]
1999-2006
1526 ( - )
ML
Mul iple
9
Yes
Kakushima N, 2011 [82]
2002-2008
- (1578)
SI
Single (La e al Ma gin Posi i i y)
7
No
Suzuki H, 2016 [83]
1999-2008
2268 (2268)
IR
Single (La e al Ma gin Posi i i y)
8
No
Ho iuchi Y, 2018 [84]
2005-2016
2551 (2585)
NCR
Mul iple
8
Yes
China
Chen ZS, 2017 [85]
2014-2015
80 (90)
SI
Single (Mul iple Lesions)
8
No
Li SJ, 2015 [86]
2011-2013
116 (116)
SI, DSI, NCR
Mul iple
8
Yes
Yan Zhang MM, 2014 [87]
2010-2013
171 (187)
SI, PR, NCR, LR
Single (Age)
8
Yes
Wen J, 2014 [88]
2006-2013
316 (319)
SI, DSI, IR
Mul iple
8
Yes
Ko ea
Lee JY, 2010 [89]
2004-2008
43 (43)
PR, IR, NCR
Single (Loca ion)
7
No
Pa k JC, 2011 [90]
2002-2010
47 (47)
SI, PR, IR, NCR
Single (Loca ion)
8
No
Kim TK, 2015 [91]
2005-2012
55 (55)
LR
Single (La e al Ma gin Posi i i y)
7
No
Jeon HK, 2018 [92]
2005-2014
66 (66)
SI, PR, IR, NCR
Mul iple
7
Yes
Kim YY, 2013 [93]
2003-2010
74 (74)
PR, IR, NCR, LR
Single (Endoscopic C i e ia)
8
No
Choi MH, 2013 [94]
2002-2012
81 (82)
SI, PR, IR, NCR, LR, ML
Single (His ology)
8
No
Gong EJ, 2016 [95]
2004-2011
88 (88)
PR, IR, NCR
Single (Loca ion)
7
Yes
Choe WH, 2018 [96]
2006-2013
90 ( - )
SI, DSI, PR, IR, LR, ML
Single (Li e Ci hosis)
9
Yes
Choi JH, 2012 [97]
2004-2010
92 ( - )
SI, DSI, PR, IR
Single (Li e Ci hosis)
8
Yes
Bae JH, 2015 [98]
2007-2013
110 (110)
PR, IR, LR
Single (Loca ion)
7
No
Myung YS, 2017 [99]
2005-2014
136 ( - )
SI, PR, IR
Single (P o on Pump Inhibi o )
8
No
Jang J, 2014 [100]
2010-2012
141 (141)
LR
Single (Endoscopic Healing Type)
7
No
Kim DY, 2014 [101]
2004-2007
142 ( - )
LR, ML
Single (Endocopic C i e ia)
8
Yes
Han JP, 2016 [102]
2001-2012
152 (152)
LR
Mul iple
8
No
Jeong JY, 2012 [103]
2006-2011
167 (161)
SI, PR
Single (Submucosal Fib osis)
7
No
Kim H, 2017 [104]
-
176 ( - )
ML
Single (Helicobac e pylo i In ec ion)
8
Yes
Chung CS, 2017 [105]
2008-2013
185 ( - )
SI, ML
Mul iple
8
Yes
Jang JS, 2009 [106]
2004-2007
198 (198)
PR, IR
Single (Size)
7
Yes
Goh PG, 2011 [107]
2005-2009
210 (210)
SI, DSI, PR, IR, LR
Mul iple
8
Yes
Kang MS, 2015 [108]
2002-2008
280 (309)
PR, IR, LR
Single (Endocopic C i e ia)
7
Yes
Kwon YH, 2014 [109]
2007-2010
283 ( - )
ML
Mul iple
8
Yes
Han JP, 2013 [110]
2001-2008
304 (335)
PR, IR, NCR
Mul iple
7
No
Kim BJ, 2010 [111]
2003-2006
337 (337)
SI, PR, IR, LR, ML
Single (Cha lson Como bidi y Scale)
7
No
Han JP, 2015 [112]
2002-2009
395 (430)
PR, IR, LR, ML
Single (His ology)
7
Yes
Lee JY, 2016 [113]
2003-2010
401 (415)
LR
Mul iple
7
Yes
Kang HY, 2010 [114]
2005-2008
- (456)
SI, IR
Single (His ology)
8
Yes
Choi MK, 2013 [115]
2006-2010
515 (522)
SI, PR, NCR, LR, ML
Single (Endocopic Indica ion)
8
Yes
Ryu DG, 2017 [116]
2009-2015
532 (557)
PR, IR
Single (His ology)
8
Yes

Sohn SH, 2017 [117]
2005-2014
599 (611)
DSI, PR, IR
Single (Endocopic Indica ion)
8
Yes
Kim JM, 2016 [118]
2010-2011
712 (737)
SI, DSI
Mul iple
8
Yes
Kim JS, 2017 [119]
2009-2015
729 ( - )
PR, NCR, LR
Mul iple
8
Yes
Kim YI, 2016 [120]
2004-2011
756 (765)
PR, IR, NCR
Single (Endocopic Indica ion)
9
Yes
Lee H, 2011 [121]
2003-2010
780 (806)
PR, IR, LR, ML
Single (Endoscopic C i e ia)
8
Yes
Ahn JY, 2011 [122]
2005-2009
- (833)
PR, IR, LR, ML
Single (Endoscopic C i e ia)
8
Yes
Pa k CH, 2013 [123]
2005-2011
916 (931)
PR, IR, NCR, LR, ML
Mul iple
8
Yes
Jung S, 2015 [124]
2007-2011
1041 (-)
SI, PR, ML
Mul iple
9
Yes
Shin KY, 2015 [125]
2003-2010
1105 (1105)
SI, DSI, PR, IR, NCR
Single (Endoscopic C i e ia)
8
No
Yang HJ, 2017 [126]
2005-2014
1115 ( - )
ML
Single (H pylo i e adica ion)
8
No
Kang D, 2017 [127]
2010-2016
1181 ( - )
SI, PR, IR, NCR
Single (BMI)
7
Yes
Yang HJ, 2018 [128]
2005-2014
1237 ( - )
LR, ML
Single (Age)
8
Yes
Hahn KY, 2016 [129]
2007-2014
1347 ( - )
LR
Mul iple
9
Yes
Min BH, 2015 [130]
2003-2011
1497 (1539)
SI, ML
Mul iple
8
Yes
Kim EH, 2016 [131]
2007-2013
1639 ( - )
NCR
Mul iple
9
Yes
Joh DH, 2015 [132]
2008-2011
1823 (1929)
PR, IR, NCR
Single (Mul iple Lesions)
9
No
Taiwan
Hsieh Y, 2015 [133]
2004-2009
65 (69)
NCR, LR, ML
Mul iple
7
No
Eu ope
Sea a Cos a R, 2018 [134]
2012-2017
105 (114)
SI, PR, IR, NCR, LR, ML
Single (Endoscopic C i e ia)
8
Yes
Libânio D, 2016 [19]
2005-2014
164 (194)
NCR
Mul iple
8
Yes
Libânio D, 2017 [9]
2005-2015
- (245)
NCR
Mul iple
9
Yes
n1 – numbe o pa ien s included in he s udy; n2 – numbe o lesions included in he s udy; MA – Included
in he me a-analysis (s udies ha epo ed isk ac o s no e alua ed in o he s udies o ha no p o ided
da a allowing calcula ion o odds a io we e no included in me a-analysis); ME-NBI – Na ow Band Imaging
Magni ica ion Endoscopy.
Table 2 – Submucosal In asion and Deep Submucosal In asion ela ed ac o s.
Ou come
Risk ac o s
Submucosal
In asion
Signi ican ly associa ed
S udies (n)
E ec Es ima e
I2
Loca ion Ve ical (MxL)
3
2.11 [1.41, 3.16]
0%
Loca ion Ve ical (UxL)
3
3.20 [1.04, 9.86]
64%
His ology
4
2.42 [1.62, 3.61]
0%
Single ac o s signi ican ly associa ed
VEC pa e n [43], submucosal ib osis [103], des uc i e mic o su ace pa e n [35], ulce a ion [74]
and me ach onous lesions [34].
No signi ican ly associa ed
S udies (n)
E ec Es ima e
I2
Lesion size (20mm)
2
1.50 [0.28, 8.14]
71%
Loca ion Ve ical (UxM)
3
1.17 [0.36, 3.80]
76%
Mo phology
3
1.05 [0.60, 1.84]
50%
HP e adica ion
2
1.35 [0.85, 2.16]
0%
Single ac o s no signi ican ly associa ed
Gas ec omy [67], PPIs adminis a ion [99], ci hosis [97], cha lson como bidi y scale (a leas one
isk ac o ) [111], BMI [127] and mul iple lesions [85].
Deep Submucosal
In asion
Signi ican ly associa ed
S udies (n)
E ec Es ima e
I2
Loca ion Ve ical (UxM)
3
2.11 [1.18, 3.79]
52%
Loca ion Ve ical (UxL)
3
2.35 [1.45,3.81]
42%
His ology
3
2.98 [2.02, 4.39]
0%
Single ac o s signi ican ly associa ed
Size o e 30mm [118], me ach onous lesions [34] and pa e n C wi h ME-NBI (no su ace pa e n
and spa se mic o essels ma kedly dis o ed, isola ed, he e ogeneous o wi h a ascula a eas) [32].
No signi ican ly associa ed
S udies (n)
E ec Es ima e
I2
Loca ion Ve ical (MxL)
3
1.12 [0.81, 1.56]
0%
Ulce a ion
3
1.42 [0.98, 2.06]
31%
Single ac o s no signi ican ly associa ed
Age [69], sex [74], size o e 20mm [72], loca ion [118], mo phology [118] and HP e adica ion [49].
n – numbe o s udies; I2 – he e ogenei y; M – middle hi d; L – lowe hi d; U – uppe hi d; VEC Pa e n –
Vessels wi hin epi helial ci cle pa e n; HP e adica ion – Helicobac e pylo i e adica ion; PPIs – P o on-
pump inhibi o s; BMI – Body Mass Index; ME-NBI – Magni ica ion Endoscopy (Na ow Band Imaging).
Table 3 – Piecemeal Resec ion and Incomple e Resec ion ela ed ac o s.
Ou come
Risk ac o s
Piecemeal
Resec ion
Signi ican ly associa ed
S udies (n)
E ec Es ima e
I2
Lesion size >20mm
5
3.20 [2.07, 4.95]
24%
Lesion size >30mm
2
2.78 [1.17, 6.60]
0%
Endoscopic Indica ion (AI x EI)
7
2.25 [1.44, 3.53]
0%
Endoscopic Indica ion (AI x BEI)
2
4.64 [1.68, 12.82]
0%
Ulce a ion
6
2.76 [1.23, 6.20]
44%
Single ac o s signi ican ly associa ed
Deg ee o ib osis [103]
No signi ican ly associa ed
S udies (n)
E ec Es ima e
I2
Age
3
1.37 [0.49, 3.79]
69%
Loca ion Ve ical (UxM)
3
1.57 [0.51, 4.80]
57%
Loca ion Ve ical (UxL)
3
3.57 [0.31, 41.12]
82%
Loca ion Ve ical (MxL)
3
2.35 [0.74, 7.43]
59%
Endoscopic Indica ion (EI x BEI)
2
1.53 [0.53, 4.37]
0%
His ology
2
1.60 [0.73, 3.53]
0%
Gas ec omy
2
2.04 [0.01, 411.2]
91%
Ci hosis
2
2.58 [0.70, 9.56]
0%
Single ac o s no signi ican ly associa ed
Mo phology [59], age o e 70 yea s [63], age o e 80 yea s [44], sex [63], mul iple lesions [132], me ach onous lesions
[132], PPIs adminis a ion [99], Cha lson como bidi y scale >=1[111], R-scope ESD [40], lea ning cu e [60] and BMI
[127].
Incomple e
Resec ion
Signi ican ly associa ed
S udies (n)
E ec Es ima e
I2
Lesion size >20mm
7
3.64 [2.24, 5.91]
63%
Lesion size >30mm
4
3.83 [2.68, 5.49]
0%
Loca ion Ve ical (UxM)
5
1.62 [1.14, 2.31]
0%
Loca ion Ve ical (UxL)
5
3.71 [2.49, 5.54]
0%
Loca ion Ve ical (MxL)
5
2.28 [1.58, 3.28]
0%
Endoscopic Indica ion (AI x EI)
3
3.86 [1.23, 12.08]
77%
Ulce a ion
6
4.06 [1.62, 10.16]
83%
Dep h o In asion (MxSM)
3
27.89 [3.57, 218.0]
91%
Dep h o In asion (M/SM1xSM2)
2
14.99 [2.84, 79.25]
56%
His ology
5
6.67 [3.42, 12.99]
66%
Deg ee o Fib osis
2
4.46 [1.66, 11.96]
69%
Single ac o s signi ican ly associa ed
Size [58], umo loca ion [58], Endoscopic Indica ion [117] and age (mean) [88].
No signi ican ly associa ed
S udies (n)
E ec Es ima e
I2
Age
4
1.04 [0.54, 1.98]
55%
Sex
2
0.96 [0.55, 1.68]
34%
Mo phology
2
0.90 [0.47, 1.75]
0%
Gas ec omy
2
0.37 [0.07, 2.15]
87%
Ci hosis
2
3.66 [0.64, 20.74]
0%
Single ac o s no signi ican ly associa ed
Sex [83], age >65 yea s [83], age >80 yea s [44], size [88], loca ion (sho axis) [68], loca ion EGJ [80], PPI
adminis a ion [99], Cha lson como bidi y scale >=1 [111], lea ning cu e phase [60], BMI [127], mul iple lesions [132]
and local ecu ence [29].
n – numbe o s udies; I2 – he e ogenei y; AI – Absolu e Indica ion; EI – Expanded Indica ion; BEI – Beyond-
Expanded Indica ion; U – uppe hi d; M – middle hi d; L – lowe hi d; PPIs – P o on-pump inhibi o s; ESD
– Endoscopic Submucosal Dissec ion; BMI – Body Mass Index; M – Mucosa; SM – submucosa; SM1 –
lesions in ading less han 500 μm om he submucosa in dep h; SM2 – lesions in ading 500 μm o mo e
om he submucosa in dep h; EGJ –Esophagogas ic junc ion.
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dissec ion o submucosal in asi e gas ic cance : a single-cen e s udy. Gas ic cance .
2012;15(1):97-105.
52. Nakamo o S, Sakai Y, Kasanuki J, e al. Indica ions o he use o endoscopic mucosal
esec ion o ea ly gas ic cance in Japan: a compa a i e s udy wi h endoscopic submucosal
dissec ion. Endoscopy. 2009;41(9):746-50.
53. Oka S, Tanaka S, Kaneko I, e al. Ad an age o endoscopic submucosal dissec ion
compa ed wi h EMR o ea ly gas ic cance . Gas oin es Endosc. 2006;64(6):877-83.
54. Imagawa A, Okada H, Kawaha a Y, e al. Endoscopic submucosal dissec ion o ea ly
gas ic cance : Resul s and deg ees o echnical di icul y as well as sucsess. Endoscopy.
2006;38(10):987-90.

55. Ka sube T, Mu ayama M, Yamaguchi K, e al. Addi ional Su ge y A e Non-cu a i e
Resec ion o ESD o Ea ly Gas ic Cance . An icance Res. 2015;35(5):2969-74.
56. Go o O, Fujishi o M, Kodashima S, e al. Ou comes o endoscopic submucosal
dissec ion o ea ly gas ic cance wi h special e e ence o alida ion o cu abili y c i e ia.
Endoscopy. 2009;41(2):118-22.
57. Ho iuchi Y, Fujisaki J, Yamamo o N, e al. Mixed poo ly di e en ia ed adenoca cinoma in
undi e en ia ed- ype ea ly gas ic cance p edic s endoscopic noncu a i e esec ion. Gas ic
Cance . 2018;21(4):689-95.
58. Takenaka R, Kawaha a Y, Okada H, e al. Fac o s Associa ed wi h Local Recu ence
and Incomple e Resec ion in Endoscopic Submucosal Dissec ion o he T ea men o Ea ly
Gas ic Cance s. Gas oin es Endosc. 2006;63(5):AB182-AB.
59. Oda I, Sai o D, Tada M, e al. A mul icen e e ospec i e s udy o endoscopic esec ion
o ea ly gas ic cance . Gas ic Cance . 2006;9(4):262-70.
60. Yoshida M, Kakushima N, Mo i K, e al. Lea ning cu e and clinical ou come o gas ic
endoscopic submucosal dissec ion pe o med by ainee ope a o s. Su g Endosc. 2016.
61. Boda T, I o M, Oka S, e al. Cha ac e is ics o me ach onous gas ic umo s a e
endoscopic submucosal dissec ion o gas ic in aepi helial neoplasms. Gas oen e ol Res
P ac . 2014;2014:863595.
62. Oha a Y, Toshikuni N, Ma sueda K, e al. The supe icial ele a ed and dep essed lesion
ype is an independen ac o associa ed wi h non-cu a i e endoscopic submucosal dissec ion
o ea ly gas ic cance . Su g Endosc. 2016;30(11):4880-8.
63. Sugimo o T, Okamo o M, Mi suno Y, e al. Endoscopic submucosal dissec ion is an
e ec i e and sa e he apy o ea ly gas ic neoplasms: a mul icen e easible s udy. J Clin
Gas oen e ol. 2012;46(2):124-9.
64. Kosaka T, Endo M, Toya Y, e al. Long- e m ou comes o endoscopic submucosal
dissec ion o ea ly gas ic cance : a single-cen e e ospec i e s udy. Dig Endosc.
2014;26(2):183-91.
65. Ohni a K, Isomo o H, Yamaguchi N, e al. Fac o s ela ed o he cu abili y o ea ly gas ic
cance wi h endoscopic submucosal dissec ion. Su g Endosc. 2009;23(12):2713-9.
66. Toyokawa T, Fuji a I, Mo ikawa T, e al. Clinical ou comes o ESD o ea ly gas ic
neoplasms in elde ly pa ien s. Eu J Clin In es . 2011;41(5):474-8.
67. Ojima T, Taki uji K, Nakamu a M, e al. Long- e m Su i al o Pa ien s Wi h Endoscopic
Submucosal Dissec ion o Remnan Gas ic Cance s. Su g Lapa osc Endosc Pe cu an Tech.
2016;26(1):78-81.
68. Go o A, Nishikawa J, Okamo o T, e al. Ou comes o endoscopic submucosal dissec ion
o ea ly gas ic cance and ac o s associa ed wi h incomple e esec ion.
Hepa ogas oen e ology. 2013;60(121):46-53.
69. Isomo o H, Shikuwa S, Yamaguchi N, e al. Endoscopic submucosal dissec ion o ea ly
gas ic cance : a la ge-scale easibili y s udy. Gu . 2009;58(3):331-6.
70. Yamaguchi N, Isomo o H, Fukuda E, e al. Clinical Ou comes o Endoscopic
Submucosal Dissec ion o Ea ly Gas ic Cance by Indica ion C i e ia. Diges ion.
2009;80(3):173-81.
71. Isomo o H, Ohni a K, Yamaguchi N, e al. Clinical ou comes o endoscopic submucosal
dissec ion in elde ly pa ien s wi h ea ly gas ic cance . Eu J Gas oen e ol Hepa ol.
2010;22(3):311-7.
72. Nagahama T, Yao K, Imamu a K, e al. Diagnos ic pe o mance o con en ional
endoscopy in he iden i ica ion o submucosal in asion by ea ly gas ic cance : he "non-
ex ension sign" as a simple diagnos ic ma ke . Gas ic Cance . 2017;20(2):304-13.
73. Hi asawa K, Kokawa A, Oka H, e al. Risk assessmen cha o cu abili y o ea ly gas ic
cance wi h endoscopic submucosal dissec ion. Gas oin es Endosc. 2011;74(6):1268-75.
74. Ho eya S, Yamashi a S, Kikuchi D, e al. Endoscopic submucosal dissec ion o
submucosal in asi e gas ic cance and cu abili y c i e ia. Dig Endosc. 2011;23(1):30-6.
75. Numa a N, Oka S, Tanaka S, e al. Risk ac o s and managemen o posi i e ho izon al
ma gin in ea ly gas ic cance esec ed by en bloc endoscopic submucosal dissec ion. Gas ic
Cance . 2015;18(2):332-8.
76. Higashimaya M, Oka S, Tanaka S, e al. Ou come o endoscopic submucosal dissec ion
o gas ic neoplasm in ela ionship o endoscopic classi ica ion o submucosal ib osis. Gas ic
Cance . 2013;16(3):404-10.
77. Oda I, Go oda T, Hamanaka H, e al. Endoscopic submucosal dissec ion o ea ly gas ic
cance : Technical easibili y, ope a ion ime and complica ions om a la ge consecu i e se ies.
Dig Endosc. 2005;17(1):54-8.
78. Maeha a Y, Nakamu a S, Esaki M, e al. Cha ac e is ics o P ima y and Me ach onous
Gas ic Cance s Disco e ed a e Helicobac e pylo i E adica ion: A Mul icen e P opensi y
Sco e-Ma ched S udy. Gu Li e . 2017;11(5):628-34.
79. Nakamu a K, Honda K, Akahoshi K, e al. Sui abili y o he expanded indica ion c i e ia
o he ea men o ea ly gas ic cance by endoscopic submucosal dissec ion: Japanese
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Gas oen e ol. 2015;50(4):413-22.
80. Ho eya S, Ma sui A, Iizuka T, e al. Compa ison o he clinicopa hological cha ac e is ics
and esul s o endoscopic submucosal dissec ion o esophagogas ic junc ion and non-
junc ional cance s. Diges ion. 2013;87(1):29-33.
81. Abe S, Oda I, Suzuki H, e al. Long- e m su eillance and ea men ou comes o
me ach onous gas ic cance occu ing a e cu a i e endoscopic submucosal dissec ion.
Endoscopy. 2015;47(12):1113-8.
82. Kakushima N, Ono H, Tanaka M, e al. Fac o s ela ed o la e al ma gin posi i i y o
cance in gas ic specimens o endoscopic submucosal dissec ion. Dig Endosc. 2011;23(3):227-
32.
83. Suzuki H, Oda I, Sekiguchi M, e al. Fac o s associa ed wi h incomple e gas ic
endoscopic submucosal dissec ion due o misdiagnosis. Endosc In Open. 2016;4(7):E788-93.
84. Ho iuchi Y, Fujisaki J, Yamamo o N, e al. Undi e en ia ed- ype componen mixed wi h
di e en ia ed- ype ea ly gas ic cance is a signi ican isk ac o o endoscopic non-cu a i e
esec ion. Dig Endosc. 2018.
85. Chen ZS, Jin XF, Wu HL, e al. Simul aneous endoscopic submucosal dissec ion o
mul iple ea ly gas ic cance s in a low olume cen e . Medicine (Bal imo e). 2017;96(36):e7745.
86. Li SJ, Wang J, Li ZY, e al. [Applica ion o endoscopic submucosal dissec ion in
ea men o ea ly gas ic cance ]. Beijing Da Xue Xue Bao Yi Xue Ban. 2015;47(6):945-51.
87. Zhang Y, Huang L, Li L, e al. Endoscopic submucosal dissec ion o ea ly gas ic
neoplasms in elde ly pa ien s. J Lapa oendosc Ad Su g Tech A. 2014;24(6):391-8.
88. Wen J, Linghu EQ, Yang YS, e al. Associa ed isk ac o analysis o posi i e esec ion
ma gins a e endoscopic submucosal dissec ion in ea ly-s age gas ic cance . J BUON.
2014;20(2):421-7.
89. Lee JY, Choi IJ, Cho SJ, e al. Endoscopic submucosal dissec ion o me ach onous
umo in he emnan s omach a e dis al gas ec omy. Su g Endosc. 2010;24(6):1360-6.
90. Pa k JC, Kim JH, Youn YH, e al. How o manage pylo ic umou s ha a e di icul o
esec comple ely wi h endoscopic esec ion: compa ison o he e o lexion s. o wa d iew
echnique. Dig Li e Dis. 2011;43(12):958-64.
91. Kim TK, Kim GH, Pa k DY, e al. Risk ac o s o local ecu ence in pa ien s wi h posi i e
la e al esec ion ma gins a e endoscopic submucosal dissec ion o ea ly gas ic cance . Su g
Endosc. 2015;29(10):2891-8.
All manusc ip s should be w i en so ha hey a e in elligible o he p o essional eade who
is no a specialis in he pa icula ield. They should be w i en in a clea , concise, di ec
s yle. Whe e con ibu ions a e judged as accep able o publica ion on he basis o con en ,
he Edi o and he Publishe ese e he igh o modi y manusc ip s o elimina e ambigui y
and epe i ion and imp o e communica ion be ween au ho and eade .
Au ho ship should be inalized du ing he submission p ocess. Please ensu e ha all
au ho s a e lis ed and in he co ec o de , because changes a e no pe missible once he
accep ed manusc ip goes in o p oduc ion.
4. AUTHORSHIP
Diges i e Endoscopy ollows he ecommenda ions o mula ed by he In e na ional
Commi ee o Medical Jou nal Edi o s ega ding c i e ia o au ho ship
(h p://www.icmje.o g/ ecommenda ions/b owse/ oles-and- esponsibili ies/de ining-
he- ole-o -au ho s-and-con ibu o s.h ml). Acco dingly, each pe son lis ed as an au ho
o coau ho o a submi ed manusc ip mus mee all ou c i e ia. An au ho o coau ho
shall ha e:
1) Subs an ial con ibu ions o he concep ion o design o he wo k, o acquisi ion, analysis
o in e p e a ion o da a o he wo k;
2) D a ing he wo k o e ising i c i ically o impo an in ellec ual con en ;
3) Final app o al o he e sion o be published;
4) Ag eemen o be accoun able o all aspec s o he wo k in ensu ing ha ques ions
ela ed o he accu acy o in eg i y o any pa o he wo k a e app op ia ely in es iga ed
and esol ed. Mee ing hese c i e ia should p o ide each au ho wi h su icien knowledge
o and pa icipa ion in he wo k ha he o she can accep public esponsibili y o he epo .
Pe son who does no mee he abo e 4 c i e ia should be men ioned in he
acknowledgmen sec ion.
The co esponding au ho mus submi an Au ho ship con i ma ion o m (wi h COI
s a emen om all au ho s) and mus gua an ee ha all au ho s lis ed in he manusc ip
mee hese c i e ia and ha all au ho s a e awa e o he submission and abou he
au ho ship. I he e is a se ious b each o au ho ship, he ma e will be in es iga ed
acco ding o he COPE guideline and ep imand and punishmen will be conside ed
acco ding o he se iousness o he ma e . Please use his o m o con i m he au ho ship
o all au ho s.
5. DISCLOSURE
Con lic o In e es s: All au ho s should decla e, acco ding o he s anda d o each
coun y, any employmen , leade ship ole o ad iso y ole wi h a company, s ockowne ship
and op ion, pa en oyal ies and licensing ees, hono a ia, ecei ed ees o p omo ional
ma e ials, inancial suppo and g an s, de ices dona ed om he indus y and o he
po en ial ela ionships ha may pose con lic o in e es s as “In e es s” be ween he
Acknowledgmen s and Re e ences sec ions. The co esponding au ho should collec all
au ho s COI disclosu e and mus comple e a con lic o in e es s disclosu e o m as pa o
he ini ial manusc ip submission p ocess. The co esponding au ho is esponsible o
ob aining all he ele an in o ma ion om all au ho s o he manusc ip . Please isi he e o
consul he de ails o he la es disclosu e guidelines acco ding o he s anda ds o he
In e na ional Commi ee o Medical Jou nal Edi o s (ICMJE).I a ailu e o accu a e epo
abou COI disclosu e is suspec ed, he ma e will be esol ed ollowing he p ocedu e
de ailed in COPE guidelines.
Please disclose all Con lic o In e es s o all au ho s using his o ma .
6. ETHICAL CONSIDERATIONS
Au ho s mus s a e ha he p o ocol o he esea ch p ojec has been app o ed by a
sui ably cons i u ed E hics Commi ee o he ins i u ion wi hin which he wo k was
unde aken and ha i con o ms o he p o isions o he Decla a ion o Helsinki (as e ised
in Fo aleza, B azil, Oc obe 2013), a ailable a : h ps://www.wma.ne /wha -we-
do/medical-e hics/decla a ion-o -helsinki/. In gene al, submission o a case epo
should be accompanied by he w i en consen o he subjec (o pa en /gua dian) be o e
publica ion; his is pa icula ly impo an whe e pho og aphs a e o be used o in cases

whe e he unique na u e o he inciden epo ed makes i possible o he pa ien o be
iden i ied. While he Edi o s ecognize ha i migh no always be possible o app op ia e o
seek such consen , he onus will be on he au ho s o demons a e ha his excep ion
applies in hei case. Any expe imen s in ol ing animals mus be demons a ed o be
e hically accep able and whe e ele an con o m o na ional guidelines o animal usage in
esea ch. Diges i e Endoscopy e ains he igh o ejec any manusc ip on he basis o
une hical conduc o ei he human o animal s udies.
Da a Sha ing and Da a Accessibili y
The jou nal encou ages au ho s o sha e he da a and o he a e ac s suppo ing he esul s
in he pape by a chi ing i in an app op ia e public eposi o y. Au ho s should include a
da a accessibili y s a emen , including a link o he eposi o y hey ha e used, in o de ha
his s a emen can be published alongside hei pape .
7. REGISTRY OF RESEARCH STUDIES INVOLVING HUMAN SUBJECTS
As shown in he Decla a ion o Helsinki (Fo aleza, B azil, Oc obe 2013), e e y esea ch
s udy in ol ing human subjec s mus be egis e ed in a publicly accessible da abase be o e
ec ui men o he i s subjec . Thus any esea ch p ojec ha assigns human subjec s o
in e en ion o compa ison g oups o s udy he cause-and-e ec ela ionship be ween a
medical in e en ion and a heal h ou come mus be egis e ed. The abo e policy applies o
e e y esea ch s udy which began wi h en ollmen o pa ien s a e No embe 1s 2013 (I
au ho s a e conside ing submi ing a non- egis e ed p ospec i ely designed esea ch s udy,
please explain he eason why i has no been egis e ed. Regis a ion o e ospec i e
s udies is no equi ed, bu mus ha e o icial app o al om an app op ia e e hical
commi ee a submission o he s udy).
Resea ch s udies men ioned abo e should be egis e ed in one o he egis ies app o ed
by ICMJE. Regis ies ha cu en ly mee all necessa y c i e ia include: (1) he egis y
sponso ed by he Uni ed S a es Na ional Lib a y o Medicine
(h p://www.clinical ials.go ); (2) he In e na ional S anda d Randomized Con olled T ial
Numbe Regis y (h p://www.con olled- ials.com/); (3) he Aus alian New Zealand
Clinical T ials Regis y (h p://www.anzc .o g.au/); (4) he Chinese Clinical T ials Regis y
(h p://www.chic .o g/); and (5) he Clinical T ials Regis y – India
(h p://www.c i.nic.in/); (6) Uni e si y Hospi al Medical In o ma ion Ne wo k (UMIN)
(h p://www.umin.ac.jp/c /).
8. RANDOMIZED CONTROLLED TRIALS
Randomized con olled ials should ollow he guidelines o he CONSORT S a emen . The
CONSORT S a emen will also be used as he c i e ia o pee e iew o andomized
con olled ial pape s: h p://www.conso -s a emen .o g/.
Please upload he Conso 2010 Checklis wi h you main ex when you submi RCT
manusc ip s.
9. MANUSCRIPT CATEGORIES AND REQUIREMENTS
(i) ORIGINAL ARTICLES
Wo d Limi : 3000 wo ds including abs ac bu excluding e e ences, ables and igu es.
Au ho s: Maximum o 29 au ho s. In case you ha e 30 au ho s o mo e, please con ac
Edi o ial O ice a diges i [email protected] .jp / [email protected] .jp p io o
submission.
Abs ac : 250 wo ds maximum, s uc u ed (subheade s): Objec i es, Me hods, Resul s,
Conclusions.
Re e ences: No limi .
Figu es/Tables: No limi .
Suppo ing In o ma ion: Video, addi ional da a, ables and audio a e accep able as
suppo ing in o ma ion.
Desc ip ion: Full-leng h epo s o cu en esea ch in ei he basic o clinical science.
A ange ex as ollows: In oduc ion, Me hods, Resul s, Discussion, Acknowledgmen ,
Con lic o In e es s, Re e ences, and when ele an , Supplemen a y Ma e ial.
(ii) REVIEW ARTICLES
Wo d Limi : 3500 wo ds including abs ac bu excluding e e ences, ables and igu es.
Au ho s: Maximum o 29 au ho s. In case you ha e 30 au ho s o mo e, please con ac
Edi o ial O ice a diges i [email protected] .jp / [email protected] .jp p io o
submission.
Abs ac : 250 wo ds maximum, s uc u ed o uns uc u ed.
Re e ences: No limi .
Figu es/Tables: No limi .
Suppo ing In o ma ion: Video, addi ional da a, ables and audio a e accep able as
suppo ing in o ma ion.
Desc ip ion: Re iews a e comp ehensi e analyses o speci ic opics wi h an inclusi e
e e ence lis , o hey may be sys ema ic e iews. Al hough na a i e e iew a icles a e
accep ed, sys ema ic e iews would be p e e able o publica ion. Some o hem will be
submi ed upon in i a ion by he Edi o . Bo h solici ed and unsolici ed e iew a icles will
unde go pee e iew p io o accep ance.
(iii) CASE REPORTS
Only cases o excep ional in e es and no el y a e conside ed. Fo manusc ip s ha do no
quali y, Edi o s may ask au ho s o sho en manusc ip s and ew i e as Le e s, Techniques
and Images.
Wo d Limi : 1500 wo ds including abs ac bu excluding e e ences, ables and igu es.
Abs ac : Sho , uns uc u ed (no use o subheade s). Maximum o 250 wo ds.
Re e ences: Up o 10 in o al.
Figu es/Tables: Up o ou in o al.
Suppo ing In o ma ion: Video, addi ional da a, ables and audio a e accep able as
suppo ing in o ma ion.
Desc ip ion: New obse a ions o diseases, clinical indings o no el/unique ea men
ou comes ele an o p ac i ione s in Endoscopy. A ange ex as ollows: Abs ac ;
In oduc ion; Case Repo ; Discussion; Acknowledgmen ; Con lic o In e es s; Re e ences.
(i ) HOW I DO IT
Wo d Limi : 3000 wo ds including abs ac bu excluding e e ences, ables and igu es.
Abs ac : 250 wo ds, uns uc u ed (no use o subheade s).
Re e ences: Up o 20 in o al.
Figu es/Tables: Up o i e in o al.
Suppo ing In o ma ion: Video, addi ional da a, ables and audio a e accep able as
suppo ing in o ma ion.
Desc ip ion: How I Do I con ains use ul clinical imp o emen s o diagnosis and
ea men . I mus be based on empi ical obse a ion and i should include discussions
abou me hods and esul s wi h e e ences. A ange ex as ollows: Abs ac ; In oduc ion;
P ocedu e o Technique; Discussion.
( ) LETTERS, TECHNIQUES AND IMAGES
Wo d Limi : 300 wo ds.
Au ho s: Maximum o h ee au ho s.
Abs ac : No abs ac .
Re e ences: Up o i e.
Figu es/Tables/Images: Up o wo. Size o one igu e should no exceed 80 mm ho izon al
x 80 mm e ical. Composi e pho os can be accep ed wi hin his size egula ion when
necessa y.
Suppo ing In o ma ion: Addi ional da a, igu es and ables a e accep able as suppo ing
in o ma ion. Videos should be submi ed o he ca ego y “DEN VIDEO ARTICLES.”
Desc ip ion: Le e s may be submi ed o he Edi o on any opic o discussion; clinical
obse a ions, as well as le e s commen ing on pape s published in ecen issues.
Manusc ip s o me ly published as New Ins umen s and Techniques, Endoscopic Images
o In e es , and Clinical T ial No es a e now published unde his manusc ip ca ego y.
( i)DEN VIDEO ARTICLES
[ONLINE ONLY]
B ie Explana ion (no s uc u ed, in one pa ag aph): Up o 300 wo ds.
Au ho s: Maximum o h ee au ho s.
Abs ac : No abs ac .
Re e ences: Up o i e.
Figu es/Tables/Images: Up o wo (se o pho og aphs will be coun ed as one igu e)
Videos: Each Video clip will be online ee o access. The o al leng h o he ideo should
no be longe han 10 minu es, and he leng h o one ideo s eam should be limi ed o 5
minu es. All ideo o ma s a e accep ed, bu au ho s should bea in mind ha m4 o mp4
a e some imes no compa ible o play/ download in In e ne Explo e o Ch ome and only
compa ible o Fi e ox. All na a ion and/ o sub i les should be in English. The ideo should
be edi ed ha he eade can unde s and and accompanied by a s uc u ed na a ion and/
o sub i le. All ideos submi ed mus be o he highes quali y possible. You may be
ad ised o e ise you ideo i i s quali y is below ou s anda ds. The ma e ials a e
published as hey a e supplied and a e no checked o copyedi ed in any way. Use
he Video A icle Templa e o p epa e he ideo. A ideo ile should be named s a ing
wi h a leas he i s 20 cha ac e s o he manusc ip i le.
I you ha e p oblem in uploading you ideo because he size o he ideo is oo big, please
con ac [email protected] .jp / diges i [email protected] .jp abou submission o he
ideo.
Desc ip ion: DEN Video A icles a e a icles wi h a ideo and a b ie explana ion
accompanying he submi ed ideo. The ideo mus show inno a i e echniques o clinically
impo an use o endoscopy wi h b ie and concise explana ion o he echniques/ clinical
impo an poin s in he ex .
A publica ion cha ge: 300 USD pe one a icle is cha ged o au ho s commencing om
submissions ecei ed a e 1 May 2018. An au ho will be eques ed o send he
comple ed page cha ge o mwi hin 3 days when a manusc ip is accep ed o publica ion.
( ii) EDITORIALS
[BY INVITATION OF EDITORS]
Wo d Limi : 1600 wo ds.
Abs ac : No abs ac .
Re e ences: Up o 10 in o al.
Desc ip ion: P oposals o Edi o ials may be submi ed; howe e , in his case, au ho s
should only send an ou line o he p oposed pape o ini ial conside a ion.
10. PREPARATION OF THE MANUSCRIPT
Au ho Se ices
P io o submission, we encou age you o b owse he ‘Au ho Resou ces’ sec ion o he
Wiley ‘Au ho Se ices’ websi e: h p://au ho se ices.wiley.com/bau ho /de aul .asp.
This si e includes use ul in o ma ion co e ing such opics as copy igh ma e s, e hics and
elec onic a wo k guidelines.
P e-accep ance English-language edi ing
Au ho s o whom English is a second language may choose o ha e hei manusc ip
p o essionally edi ed be o e submission o imp o e he English. Visi ou si e o lea n
abou he op ions. All se ices a e paid o and a anged by he au ho . Please no e using
he Wiley English Language Edi ing Se ice does no gua an ee ha you pape will be
accep ed by his jou nal.
Op imizing You A icle o Sea ch Engines
Many s uden s and esea che s looking o in o ma ion online will use sea ch engines such
as Google, Yahoo o simila . By op imizing you a icle o sea ch engines, you will inc ease
he chance o someone inding i . This in u n will make i mo e likely o be iewed and/o
ci ed in ano he wo k. We ha e compiled hese guidelines o enable you o maximize he
web- iendliness o he mos public pa o you a icle.
S yle
Manusc ip s Submi ed o Biomedical Jou nals: W i ing and Edi ing o Biomedical
Publica ions’ as p esen ed a : h p://www.ICMJE.o g/.
Spelling: The jou nal uses US spelling and au ho s should he e o e ollow he la es
edi ion o he Me iam–Webs e ’s Collegia e Dic iona y.
Uni s: All measu emen s mus be gi en in SI o SI-de i ed uni s. S a is ics and
measu emen s should always be gi en in nume als; ha is, 10 mm. Con using
ma hema ical no a ion, and pa icula ly subsc ip s and supe sc ip s, should be a oided. Fo
mo e in o ma ion abou SI uni s, please go o he Bu eau In e na ional des Poids e
Mesu es (BIPM) websi e a : h p://www.bipm. /.
Abb e ia ions and Ac onyms: S anda d abb e ia ions may be used and should be
de ined in he abs ac and on i s men ion in he ex . In gene al, howe e , abb e ia ions
should be used spa ingly and only whe e hey ease he eade ’s ask by educing epe i ion
o long, echnical e ms. Ini ially use he wo d in ull, ollowed by he abb e ia ion in
pa en heses. The ea e , use he abb e ia ion.
T ade Names: D ugs should be e e ed o by hei gene ic names. I p op ie a y d ugs
ha e been used in he s udy, e e o hese by hei gene ic name, men ioning he
p op ie a y name, and he name and loca ion o he manu ac u e , in pa en heses.
11. STRUCTURE OF MANUSCRIPTS
The leng h o manusc ip s mus adhe e o he speci ica ions unde he sec ion Manusc ip
Ca ego ies.
Manusc ip s should be p esen ed in he ollowing o de : (i) i le page; (ii) abs ac and key
wo ds; (iii) ex ; (i ) acknowledgmen s; ( ) con lic s o in e es ; ( i) e e ences; ( ii)
suppo ing in o ma ion; ( iii) igu e legends; (ix) ables (each able comple e wi h i le and
oo no es); and (x) igu es. Foo no es o he ex a e no allowed and any such ma e ial
should be inco po a ed in o he ex as pa en he ical ma e .
TITLE PAGE
The i le page should con ain: (i) he i le o he pape ; (ii) he ull names o he au ho s; and
(iii) he add esses o he ins i u ions a which he wo k was ca ied ou oge he wi h (i ) he
name, he ull pos al and email add ess, plus acsimile and elephone numbe s, o he
au ho o whom co espondence abou he manusc ip should be sen .
The p esen add ess o any au ho , i di e en om ha whe e he wo k was ca ied ou ,
should be supplied in a oo no e. In keeping wi h he la es guidelines o he In e na ional
Commi ee o Medical Jou nal Edi o s, each au ho 's con ibu ion o he pape is o be
quan i ied. The i le should be sho , in o ma i e and con ain he majo key wo ds. A sho
unning i le (less han 40 cha ac e s including spaces) should also be p o ided. The
unning i le is he sho i le in he uppe igh -hand co ne o he a icle o help acili a e
a icle sea ch.
ABSTRACT AND KEYWORDS
The leng h o abs ac s mus adhe e o he speci ica ions unde he sec ion Manusc ip
Ca ego ies. Please no e ha he equi emen s di e be ween manusc ip ypes. The
abs ac should no con ain abb e ia ions o e e ences.
Fi e key wo ds, o he pu poses o indexing, should be supplied below he abs ac , in
alphabe ical o de , and should be aken om hose ecommended by he US Na ional
Lib a y o Medicine’s Medical Subjec Headings (MeSH) B owse lis
a : h p://www.nlm.nih.go /mesh/meshhome.h ml.
TEXT
Please no e ha he equi emen s di e be ween manusc ip ypes. Please e e o he
sec ion Manusc ip Ca ego ies o indi idual equi emen s.
ACKNOWLEDGMENTS
The con ibu ion o colleagues o ins i u ions should be acknowledged. Thanks o
anonymous e iewe s a e no app op ia e.
CONFLICT OF INTERESTS
Au ho s a e equi ed o disclose any con lic o in e es s. The s a emen should be he
same as on he Au ho Submission Requi emen Fo m. The absence o any in e es o
disclose mus also be s a ed.
REFERENCES
The Vancou e sys em o e e encing should be used. In he ex , e e ences should be
ci ed using supe sc ip A abic nume als in he o de in which hey appea . I ci ed only in
ables o igu e legends, numbe hem acco ding o he i s iden i ica ion o he able o
igu e in he ex .
In he e e ences lis , he e e ences should be numbe ed and lis ed in o de o appea ance
in he ex . Ci e he names o all au ho s when he e a e six o ewe ; when se en o mo e
au ho s, lis he i s h ee ollowed by e al. Re e ence o unpublished da a and pe sonal
communica ions should no appea in he e e ences lis bu should be ci ed in he ex only
(e.g. Smi h A, 2000, unpubl. da a). All ci a ions men ioned in he ex , ables o igu es mus
be lis ed in he e e ences lis .
Names o jou nals should be abb e ia ed in he s yle used in Index Medicus.
Au ho s a e esponsible o he accu acy o all e e ences.
S anda d Jou nal A icle:
1 Oda I, Go oda T, Hamanaka H e al. Endoscopic submucosal dissec ion o ea ly gas ic
cance : Technical easibili y, ope a ion ime and complica ions om a la ge consecu i e
se ies. Dig. Endosc.2004; 17: 54–8.
S anda d Jou nal A icle using DOI: a icles published online in ad ance wi hou
olume, issue, o page numbe . The DOI will emain alid and allow an a icle o be
acked e en a e i s alloca ion o an issue. (Mo e in o ma ion abou
DOIs: h p://www.doi.o g/ aq.h ml):
2 Noda Y, Fuji a N, Kobayashi G e al. P ospec i e andomized con olled s udy compa ing
cell block me hod and con en ional smea me hod o panc ea ic juice cy ology. Dig.
Endosc. Published online: 13 Jul 2011; DOI:10.1111/j.1443-1661.2011.01180.x
Book: 3 Yamada T. P inciples o Clinical Gas oen e ology. Blackwell Publishing, Bos on,
2008.
Chap e in an Edi ed Book: 4 Ginsbe g GG. Endoscopic equipmen . In: Co on PB
(ed). Ad anced Diges i e Endoscopy: P ac ice and Sa e y. Blackwell Publishing, Bos on,
2008; 43–76.
Ci a ion o a web page: 5 AMA. helping doc o s help pa ien s [In e ne ]. Chicago:
Ame ican Medical Associa ion; c1995-2007 [ci ed 2007 Feb 22]. A ailable om:
h p://www.ama-assn.o g/.
Ci a ion o a web page wi h au ho s: 6 D'Alessand o DM, D'Alessand o MP. Vi ual
Pedia ic Hospi al™: a digi al lib a y o pedia ic in o ma ion [In e ne ]. [Iowa Ci y (IA)]:
Donna M. D'Alessand o; c1992-2007 [ e ised 2006 Jul 20; ci ed 2007 Feb 20]. A ailable
om: h p://www. i ualpedia ichospi al.o g/.
TABLES
Tables should be sel -con ained and complemen , bu no duplica e, in o ma ion con ained
in he ex . Numbe ables consecu i ely in he ex in A abic nume als. Type ables on a
sepa a e page wi h he legend abo e. Legends should be concise bu comp ehensi e – he
able, legend and oo no es mus be unde s andable wi hou e e ence o he ex . Ve ical
lines should no be used o sepa a e columns. Column headings should be b ie , wi h uni s
o measu emen in pa en heses; all abb e ia ions mus be de ined in oo no es. Foo no e
symbols: � , ‡, §, ¶, should be used (in ha o de ) and *, **, *** should be ese ed o P-
alues. S a is ical measu es such as SD o SEM should be iden i ied in he headings. I
ables ha e been ep oduced om ano he sou ce, a le e om he copy igh holde
(usually he Publishe ) s a ing au ho iza ion o ep oduce he ma e ial mus be a ached o
he co e ing le e .
FIGURES
All illus a ions (line d awings and pho og aphs) a e classi ied as igu es. Figu es should be
ci ed in consecu i e o de in he ex . Figu es should be sized o i wi hin he column (80.5
mm), in e media e (112 mm) o he ull ex wid h (168 mm). Magni ica ions should be
indica ed using a scale ba on he illus a ion. Line igu es should be sha p, black and whi e
g aphs o diag ams, d awn p o essionally o wi h a compu e g aphics package. Le e ing
mus be included and should be sized o be no la ge han he jou nal ex . Magni ica ions
should be indica ed using a scale ba on he illus a ion.

I igu es ha e been ep oduced om ano he sou ce, a le e om he copy igh holde
(usually he Publishe ) s a ing au ho iza ion o ep oduce he ma e ial mus be a ached o
he Au ho Submission Requi emen Fo m and also explici ly explained on he co e ing
le e .
Line Figu es: Mus be sha p, black and whi e g aphs o diag ams, d awn p o essionally o
wi h a compu e g aphics package.
Tex Sizing in Figu es: Le e ing mus be included and should be sized o be no la ge
han he jou nal ex o 8 poin s (should be eadable a e educ ion – a oid la ge ype o
hick lines.)
Line Wid h: Be ween 0.5 and 1 poin .
Figu e Legends Type igu e legends on a sepa a e page. Legends should be concise bu
comp ehensi e – he igu e and i s legend mus be unde s andable wi hou e e ence o he
ex . Include de ini ions o any symbols used and de ine/explain all abb e ia ions and uni s
o measu emen . Mo e help on p epa a ion o illus a ions can be ound
a : h p://au ho se ices.wiley.com/bau ho /illus a ion.asp
EQUATIONS
Equa ions should be numbe ed sequen ially wi h A abic nume als; hese should be anged
igh in pa en heses. All a iables should appea in i alics. Use he simples possible o m
o all ma hema ical symbols.
dx/d = c(x − x3/3 y z) (1)
DY/DT = −(X BY − A)/C (2)
12. SUPPORTING INFORMATION
Suppo ing In o ma ion is p o ided by he au ho s o suppo he con en o an a icle bu i
is no in eg al o ha a icle. Suppo ing In o ma ion is hos ed ia a link on Wiley Online
Lib a y, bu does no appea in he p in e sion o he a icle. Suppo ing In o ma ion mus
be submi ed oge he wi h he a icle o pee e iew; i should no be added a a la e
s age. I can be in he o m o ables, igu es, appendices, audio and ideo oo age.
Re e ence o Suppo ing In o ma ion in he main body o he a icle is allowed. Howe e , i
should be no ed ha excessi e e e ence o a piece o Suppo ing In o ma ion may indica e
ha i would be be e sui ed as a p ope e e ence o a ully included igu e/ able. The
ma e ials a e published as hey a e supplied and a e no checked o ypese in any way. All
Suppo ing In o ma ion iles should come wi h a legend, lis ed a he end o he main a icle.
Each igu e and able ile should no be la ge han 5 MB, al hough ideo iles may be
la ge . I you ha e p oblem in uploading you ideo because he size o he ideo is oo big,
please con ac [email protected] .jp / diges i [email protected] .jp abou submission
o he ideo. All ideos submi ed mus be o he highes quali y possible. P io o
submission, please check he guidelines
a : h p://au ho se ices.wiley.com/bau ho /suppma .asp.
13. SUBMISSION REQUIREMENTS
Manusc ip s mus be submi ed online a : h p://mc.manusc ip cen al.com/den/.
Au ho s mus supply an email add ess as all co espondence will be by email. Two iles
should be supplied: he co e ing le e and he manusc ip (in Wo d o ich ex o ma (. )).
The co e ing le e should be uploaded as a ile no o e iew.
COVERING LETTER
Pape s a e accep ed o publica ion in he jou nal on he unde s anding ha he con en has
no been published o submi ed o publica ion elsewhe e. This mus be s a ed in he
co e ing le e . The co e ing le e mus con ain an acknowledgmen ha all he au ho s
ha e con ibu ed signi ican ly, and ha all au ho s a e in ag eemen wi h he con en o he
manusc ip . In keeping wi h he la es guidelines o he In e na ional Commi ee o Medical
Jou nal Edi o s, each au ho ’s con ibu ion o he pape is o be quan i ied. I ables o
igu es ha e been ep oduced om ano he sou ce, a le e om he copy igh holde
(usually he Publishe s a ing au ho iza ion o ep oduce he ma e ial) mus be a ached o
he co e ing le e .
14. NO PUBLICATION FEES
Up o ou colo illus a ions, i judged ele an and o good quali y, will be published ee o
cha ge. A cha ge o A$550/US$265/¥32,000 o he i h and subsequen colo igu es will
be cha ged o he au ho . Composi e colo pho og aphs made up o smalle pic u es will no
be accep ed.
Fo DEN Video A icles, a publica ion cha ge o 300 USD is cha ged o au ho s
commencing om submissions ecei ed a e 1 May 2018. A o m eques ing paymen will
be a ailable o download wi h you PDF p oo .
15. PUBLICATION PROCESS AFTER ACCEPTANCE
Accep ed pape s will be passed o Wiley’s p oduc ion eam o publica ion. The au ho
iden i ied as he o mal co esponding au ho o he pape will ecei e an email p omp ing
hem o login in o Wiley’s Au ho Se ices, whe e ia he Wiley Au ho Licensing Se ice
(WALS) hey will be asked o comple e an elec onic license ag eemen on behal o all
au ho s on he pape . Mo e de ails on he copy igh and licensing op ions o he jou nal
appea below.
Wiley’s Au ho Se ices
Au ho Se ices enables au ho s o ack hei a icle h ough he p oduc ion p ocess o
publica ion online and in p in . Au ho s can check he s a us o hei a icles online and
choose o ecei e au oma ed e-mails a key s ages o p oduc ion. The co esponding
au ho will ecei e a unique link ha enables hem o egis e and ha e hei a icle
au oma ically added o he sys em. Please ensu e ha a comple e e-mail add ess is
p o ided when submi ing he manusc ip . Visi h p://www.au ho se ices.wiley.com/ o
mo e de ails on online p oduc ion acking and o a weal h o esou ces including FAQs
and ips on a icle p epa a ion, submission and mo e.
Accep ed A icles
The jou nal o e s Wiley’s Accep ed A icles se ice o all manusc ip s. This se ice
ensu es ha accep ed ‘in p ess’ manusc ip s a e published online e y soon a e
accep ance, p io o copy-edi ing o ypese ing. Accep ed A icles a e published online a
ew days a e inal accep ance, appea in PDF o ma only, a e gi en a Digi al Objec
Iden i ie (DOI), which allows hem o be ci ed and acked, and a e indexed by PubMed.
A e p in publica ion, he DOI emains alid and can con inue o be used o ci e and
access he a icle. The Accep ed A icles se ice has been designed o ensu e he ea lies
possible ci cula ion o esea ch pape s a e accep ance. Gi en ha copy igh licensing is a
condi ion o publica ion, au ho s a e equi ed o comple e a copy igh license be o e
manusc ip s can be p ocessed as an Accep ed A icle.
Accep ed a icles will be indexed by PubMed; he e o e he submi ing au ho mus ca e ully
check he names and a ilia ions o all au ho s p o ided in he co e page o he
manusc ip , as i will no be possible o al e hese once a pape is made a ailable online in
Accep ed A icle o ma . Subsequen ly he inal copyedi ed and p oo ed a icles will appea
in an issue on Wiley Online Lib a y; he link o he a icle in PubMed will au oma ically be
upda ed.
P oo s
Once he pape has been ypese he co esponding au ho will ecei e an e-mail ale
con aining ins uc ions on how o p o ide p oo co ec ions o he a icle. I is he e o e
essen ial ha a wo king e-mail add ess is p o ided o he co esponding au ho . P oo s
should be co ec ed ca e ully; esponsibili y o de ec ing e o s lies wi h he au ho .
Ea ly View
The jou nal o e s apid speed o publica ion ia Wiley’s Ea ly View se ice. Ea ly View
a icles a e comple e ull- ex a icles published online in ad ance o hei publica ion in a
p in ed issue. Ea ly View a icles a e comple e and inal. They ha e been ully e iewed,
e ised and edi ed o publica ion, and he au ho s' inal co ec ions ha e been
inco po a ed. Because hey a e in inal o m, no changes can be made a e online
publica ion. Ea ly View a icles a e gi en a Digi al Objec Iden i ie (DOI), which allows he
a icle o be ci ed and acked be o e alloca ion o an issue. A e p in publica ion, he DOI
emains alid and can con inue o be used o ci e and access he a icle. Mo e in o ma ion
abou DOIs can be ound a h p://www.doi.o g/ aq.h ml.
O p in s
A PDF ep in o he a icle will be supplied ee o cha ge o he co esponding au ho .
Addi ional p in ed o p in s may be o de ed online o a ee. Please click on he ollowing
link and ill in he necessa y de ails and ensu e ha you ype in o ma ion in all o he
equi ed ields: h p://www.she idan.com/wiley/eoc.
Au ho Ma ke ing Toolki
The Wiley Au ho Ma ke ing Toolki p o ides au ho s wi h suppo on how o use social
media, publici y, con e ences, mul imedia, email and he web o p omo e hei a icle.
16. COPYRIGHT, LICENSING AND ONLINE OPEN
Accep ed pape s will be passed o Wiley’s p oduc ion eam o publica ion. The au ho
iden i ied as he o mal co esponding au ho o he pape will ecei e an email p omp ing
hem o login in o Wiley’s Au ho Se ices, whe e ia he Wiley Au ho Licensing Se ice
(WALS) hey will be asked o comple e an elec onic license ag eemen on behal o all
au ho s on he pape .
Au ho s may choose o publish unde he e ms o he jou nal’s s anda d copy igh ans e
ag eemen (CTA), o unde open access e ms made a ailable ia Wiley OnlineOpen.
S anda d Copy igh T ans e Ag eemen : FAQs abou he e ms and condi ions o he
s anda d CTA in place o he jou nal, including s anda d e ms ega ding a chi ing o he
accep ed e sion o he pape , a e a ailable a : Copy igh Te ms and Condi ions FAQs.
No e ha in signing he jou nal’s license ag eemen au ho s ag ee ha consen o
ep oduce igu es om ano he sou ce has been ob ained.
OnlineOpen – Wiley’s Open Access Op ion: OnlineOpen is a ailable o au ho s o
a icles who wish o make hei a icle eely a ailable o all on Wiley Online Lib a y unde a
C ea i e Commons license. Wi h OnlineOpen, he au ho , he au ho 's unding agency, o
he au ho 's ins i u ion pays a ee o ensu e ha he a icle is made open access. Au ho s o
OnlineOpen a icles a e pe mi ed o pos he inal, published PDF o hei a icle on hei
pe sonal websi e, and in an ins i u ional eposi o y o o he ee public se e immedia ely
a e publica ion. All OnlineOpen a icles a e ea ed in he same way as any o he a icle.
They go h ough he jou nal's s anda d pee - e iew p ocess and will be accep ed o
ejec ed based on hei own me i .
OnlineOpen licenses. Au ho s choosing OnlineOpen e ain copy igh in hei a icle and
ha e a choice o publishing unde he ollowing C ea i e Commons License e ms: C ea i e
Commons A ibu ion License (CC BY); C ea i e Commons A ibu ion Non-Comme cial
License (CC BY NC); C ea i e Commons A ibu ion Non-Comme cial-NoDe i s License
(CC BY NC ND). To p e iew he e ms and condi ions o hese open access ag eemen s
please isi he Copy igh Te ms and Condi ions FAQs.
Funde Open Access and Sel -A chi ing Compliance: Please click he e o mo e
in o ma ion on Wiley’s compliance wi h speci ic Funde Open Access and Sel A chi ing
Policies, and click he e o mo e de ailed in o ma ion speci ically abou Sel -A chi ing
de ini ions and policies.
17. EDITORIAL OFFICE ADDRESS
Edi o ial O ice
Diges i e Endoscopy
Shin-ochanomizu U ban T ini y Bldg. 4F,
3-2-1 Kandasu ugadai, Chiyoda-ku,
Tokyo 101-0062, Japan
Email: diges i [email protected] .jp, [email protected] .jp
Tel: 81-3-3525-4670
Fax: 81-3-3525-4677
Au ho Guidelines upda ed 28 Feb ua y 2019
Ag adecimen os
Em p imei o luga , um especial ag adecimen o ao Dou o Diogo Libânio pela
o ien ação e apoio incondicional, pelo exemplo de igo cien í ico e pela o al
disponibilidade e a quem ag adeço, ainda, a con iança deposi ada em mim e nas
minhas capacidades.
Ao P o esso Dou o Má io Dinis Ribei o po me e dado a opo unidade de
ealiza es e p oje o com a sua equipa e ainda pela ines imá el ajuda na
concep ualização e e isão do abalho.
Ao P o esso Dou o Ped o Pimen el Nunes o con ibu o indispensá el à
conc e ização e inalização des a ese.
Finalmen e, um especial ag adecimen o à minha amília, amigos e colegas que
acompanha am es a jo nada e cujo apoio me oi imp escindí el.