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ESD around the world: Europe.

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Summary

Endoscopic submucosal dissection (ESD) offers en bloc resection of large gastrointestinal lesions. However, its clinical value in Europe is uncertain due to limited expertise, potentially yielding less favorable outcomes compared to Japan.

Keywords:
Early colorectal neoplasiaEarly esophageal carcinomaEarly gastric carcinomaEndoscopic mucosal resectionEndoscopic submucosal dissection

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Area of Science:

  • Gastroenterology
  • Endoscopic Surgery
  • Oncology

Background:

  • Endoscopic mucosal resection (EMR) is standard in Europe for early neoplasia diagnosis and staging.
  • Endoscopic submucosal dissection (ESD) enables single-piece resection of larger lesions.
  • Existing ESD data primarily originates from Japan, with limited applicability to Western settings.

Purpose of the Study:

  • To evaluate the clinical utility and outcomes of endoscopic submucosal dissection (ESD) in the European context.
  • To compare the effectiveness of ESD with established methods like EMR for early neoplasia.
  • To address the knowledge gap regarding ESD's performance in Europe given differing expertise levels.

Main Methods:

  • Review of existing literature on endoscopic submucosal dissection (ESD) in Europe and Japan.
  • Analysis of histopathologic evaluation and staging changes post-EMR and ESD.
  • Assessment of lesion resection characteristics, particularly en bloc resection capability of ESD.

Main Results:

  • EMR is established for accurate histopathologic evaluation, impacting neoplasia grading and staging.
  • ESD allows for en bloc resection of larger lesions, a key advantage over EMR.
  • European ESD outcomes may be less favorable due to limited expertise compared to Japanese data.

Conclusions:

  • ESD has potential for large lesion resection but requires further validation in Europe.
  • Western expertise in ESD may influence its clinical outcomes and applicability.
  • More European-based evidence is needed to establish ESD's role in managing early neoplasia.