ENDOSCOPIC SUBMUCOSAL DISSECTION IN THE UPPER GASTROINTESTINAL TRACT: PRESENT AND FUTURE VIEW OF EUROPE
Article first published online: 22 JUN 2009
© 2009 The Author. © 2009 Japan Gastroenterological Endoscopy Society
Special Issue: Proceedings of the Endoscopy Forum, Japan 2007–2008
Volume 21, Issue Supplement s1, pages S4–S6, July 2009
How to Cite
Neuhaus, H. (2009), ENDOSCOPIC SUBMUCOSAL DISSECTION IN THE UPPER GASTROINTESTINAL TRACT: PRESENT AND FUTURE VIEW OF EUROPE. Digestive Endoscopy, 21: S4–S6. doi: 10.1111/j.1443-1661.2009.00864.x
- Issue published online: 22 JUN 2009
- Article first published online: 22 JUN 2009
- Received 22 January 2009; accepted 22 January 2009.
- early Barrett`s neoplasia;
- early gastric cancer;
In Western countries endoscopic mucosal resection (EMR) has been widely accepted for treatment of early Barrett`s neoplasia and flat or depressed colorectal adenomas. In contrast endoscopic submucosal dissection (ESD) is infrequently performed for several reasons. It seems to be difficult to overcome the learning curve of this difficult technique because of the low case volume of early gastric cancer. On the other hand ESD of esophageal or colorectal lesions is even more challenging and is considered to be inappropriate for learning. In addition the indication for esophageal or colorectal ESD is controversial in view of excellent results of the well established EMR technique which is less time-consuming and safer than ESD. A recent survey of leading Western endoscopy centers indicated the limited experience with ESD with a low number of cases for all potential indications. Only a few training courses have been established and the number of ongoing clinical studies is limited. Only 12 out of 340 published articles on “endoscopic mucosal dissection” were reported from Western countries.
A better acceptance of ESD requires improvement of the technique to allow an easier, faster and safer approach. There is a strong demand for structured training courses and limitations of human cases to selected centers which participate in prospective trials. A close collaboration between Western and Asian centers is recommended for improvement of the ESD technique and its clinical application.