Endoscopic Submucosal Dissection: The Western Experience
1University of São Paulo, São Paulo, Brazil
2Federal University of Minas Gerais, Belo Horizonte, Brazil
3Cleveland Clinic, Cleveland, USA
4Beneficência Portuguesa, São Paulo, Brazil
5University of Porto, Porto, Portugal
Endoscopic Submucosal Dissection: The Western Experience
Description
Gastrointestinal cancer (GIC) is one of the leading causes of mortality worldwide. When detected at early stages, GIC may present as a disease confined to the gastrointestinal wall, with a more favorable prognosis. When GIC is restricted to the mucosa and superficial submucosa, the risk of vascular metastasis is low, making the cure of GIC by endoscopic resection possible.
From the possible endoscopic techniques for the treatment of GIC, endoscopic submucosal dissection made the en bloc resection of large extensions of mucosa and submucosa with high curative rates for esophageal, gastric, and colorectal neoplasms possible. The downside of ESD consists on the long learning curve and the relatively high adverse event rate when compared to other endoscopic treatments such as endoscopic mucosal resection (EMR) and thermal ablation.
The ESD technique was described in Japan and gained popularity in other eastern countries such as Korea and China. However, ESD has not been widely adopted by Western centers, probably due to the above-mentioned limitations. On the other hand, there are a few successful experiences with ESD in the West, suggesting that there is latent potential on the use of ESD in Western countries.
Potential topics include but are not limited to the following:
- The successful experiences with ESD in the West, their results, local adaptations, and how they have overcome the hurdles of implementation of this refined technique
- The ESD masters’ advices for those who intend to embark on the implementation of this technique
- Quality criteria for ESD results
- Innovations on the ESD technique
- Prevention and management of ESD adverse events
- Systematic reviews on ESD
- State of the art papers on the current situation of ESD
- Comparative studies of endoscopic and other minimally invasive treatments of GI luminal neoplasms
- Combined endoscopic and surgical treatments (e.g., full thickness resection) of GI neoplasms
- The impact of endoscopic suturing in the management of GI luminal neoplasms