Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• Endoscopic submucosal dissection (ESD) is the gold standard for en bloc resection of large superficial gastrointestinal tumors.
• European adoption of ESD is limited, with low case volumes and few published reports.
• A 2008 expert panel convened to address indications, training, and broader implementation of ESD.

Purpose of the Study:

• To establish consensus on ESD indications, quality standards, and training requirements.
• To promote the wider and safer adoption of ESD in Europe.
• To define essential institutional and training prerequisites for performing ESD.

Main Methods:

• A panel of experts and participants reached consensus on five general statements regarding ESD.
• Recommendations were made for a step-up approach to ESD based on lesion location.
• Guidelines were established for case registration, including indication, technique, results, complications, and follow-up.

Main Results:

• Consensus was reached on ESD's aim for R0 resection of mucosal cancer, adherence to quality standards, and guideline-based performance.
• A step-up approach for ESD was recommended, starting with simpler locations (rectum, distal stomach) and progressing to more complex ones (esophagus).
• Minimal institutional requirements (imaging, pathology, follow-up) and training prerequisites (knowledge, expert exposure, hands-on experience) were defined.

Conclusions:

• ESD requires high expertise, necessitating standardized training and institutional support.
• Registration of ESD cases is advised for quality control and data collection.
• Experts agreed on minimal requirements but not on minimum caseloads or restriction to expert centers.