ASGE-JGES Endoscopic Submucosal Dissection ESD (Live and Virtual) | October 2025-Sano_Indications and Preprocedural Eval for Lower ESD

Sano_Indications and Preprocedural Eval for Lower ESD

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This presentation by Dr. Yasushi Sano focuses on the indications and preprocedural evaluation for lower gastrointestinal endoscopic submucosal dissection (ESD), emphasizing the importance of detailed endoscopic diagnosis of colorectal neoplasia. Dr. Sano highlights how precise characterization of lesions impacts treatment decisions—whether to leave lesions in situ, perform polypectomy, endoscopic mucosal resection (EMR), ESD, or surgery—thus optimizing patient outcomes and reducing unnecessary procedures.<br /><br />The talk contrasts pathological diagnostic approaches between Japan and Western countries, underscoring differences in classification systems such as the Vienna and Japanese guidelines. It introduces the Japan NBI Expert Team (JNET) classification, developed to address limitations of the simpler NICE classification, particularly its low high-confidence prediction rate and broad category definitions. JNET categorizes lesions into four types (1, 2A, 2B, 3) based on vessel and surface patterns visualized via magnifying narrow-band imaging, aiding in distinguishing hyperplastic polyps, adenomas, intramucosal neoplasia, and invasive cancers.<br /><br />Supporting studies validate the JNET classification’s high diagnostic accuracy using dual-focus digital magnifying endoscopy, which enhances lesion visualization and improves depth of invasion estimation critical for treatment planning. Examples include correlation of pit patterns and vascular features with histopathology and detailed case discussions demonstrating clinical decision-making based on JNET types.<br /><br />The presentation stresses that endoscopic diagnosis is essential for selecting the appropriate intervention strategy, avoiding overtreatment of early colorectal cancers, and ensuring adequate lesion resection margins. Furthermore, dissemination and international adoption of the JNET classification are encouraged to improve global colorectal neoplasia management. Future efforts include training seminars and published atlases to aid physicians worldwide in integrating these advanced endoscopic diagnostic techniques into clinical practice.

Keywords

Lower gastrointestinal endoscopic submucosal dissection

Colorectal neoplasia diagnosis

JNET classification

Narrow-band imaging

Magnifying endoscopy

Vienna and Japanese pathological guidelines

Endoscopic mucosal resection

Lesion characterization

Colorectal cancer treatment planning

Global adoption of endoscopic techniques