Early Gastric Cancer and Endoscopic Submucosal Dissection: A Welcome Addition to the Western Endoscopist’s Tool Belt?

Luca De Luca*

Department of Internal Medicine, Gastroenterology and Digestive Endoscopy Unit, Ospedali Riuniti Marche Nord, Italy

^*Correspondance to: Luca De Luca 

 PDF  Full Text DOI: 10.25107/2474-1647.2837

Abstract

ESD was introduced in Japan for the mini-invasive treatment of EGC, as part of national screening program considering high prevalence of disease in these latitudes. Resection of early stage gastric neoplasia, including dysplastic lesions and tumors limited to the mucosa or submucosa, is core business of endoscopists in Eastern world. This technique allows en-bloc curative oncological excision and to obtain in a single step R0-resection, characterization, histological staging and potential cure of the tumor with a very high cost-benefit balance. Over the years, Western endoscopists have adopted ESD achieving good rates of efficacy, long-term improved outcomes and safety with low risk of local recurrence comparable to those obtained in Asian institutes. Despite the lowest prevalence of gastric cancer in Europe, the poor volume data and the limited experience in Western countries, endoscopists have adopted Japanese guidelines and developed a European core curriculum for ESD training. Nowadays, in Western countries ESD is an accepted first-line therapy of superficial gastric neoplasia and surgery can be reserved and used as a rescue therapy. From an ethical point of view, patients should be referred to specialized institutes where advanced diagnostic and therapeutic endoscopy is standardized, there are multidisciplinary teams for appropriate management, and certified training programs are implemented.

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Cite the article

De Luca L. Early Gastric Cancer and Endoscopic Submucosal Dissection: A Welcome Addition to the Western Endoscopist’s Tool Belt?. Clin Surg. 2020; 5: 2837..