ASGE JGES Primer ESD | September 2022-Aihara

Aihara_ESD

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This document provides an overview of the fundamentals of Endoscopic Submucosal Dissection (ESD) and appropriate patient selection. ESD is a minimally invasive procedure used to remove superficial gastrointestinal lesions. The history and development of ESD techniques and tools are discussed, including the various knives and devices used in the procedure. The indications for ESD are outlined, including low-grade dysplasia, high-grade dysplasia, intramucosal carcinoma, and superficial submucosal carcinoma. Guidelines from the Japan Gastroenterological Endoscopy Society (JGES) and the National Comprehensive Cancer Network (NCCN) are referenced to support the use of ESD in specific cases.<br /><br />The advantages of ESD over other procedures, such as endoscopic mucosal resection (EMR) and surgery, are highlighted. ESD allows for en-bloc resection regardless of lesion size, accurate histopathological analysis, and curative resection for superficial cancers. The importance of curative resection, which involves removing all malignant tissue with negative resection margins, is emphasized.<br /><br />The document also discusses the steps of cancer metastasis and the factors considered in determining curative resection. The roles of T staging with endoscopic ultrasound (EUS) and pre-ESD narrow-band imaging (NBI) in determining appropriate cases for ESD are explained. In cases where complete resection is not possible with ESD, surgical intervention may be necessary.<br /><br />Clinical outcomes of ESD compared to EMR and surgery are presented, including lower local recurrence rates, minimal adverse events, and the ability to spare organs and avoid hospital stays and postsurgical pain.<br /><br />Overall, the document concludes that ESD offers several advantages over other treatment options and is a valuable technique for the curative resection of superficial gastrointestinal lesions.

Keywords

Endoscopic Submucosal Dissection

ESD

minimally invasive procedure

gastrointestinal lesions

knives and devices

indications for ESD

curative resection

cancer metastasis

endoscopic ultrasound

clinical outcomes