How to establish endoscopic submucosal dissection in Western countries

Table 1 Indications for endoscopic en-bloc resection of gastrointestinal neoplasias (modified from[6])

Organ	Indications for …	Ref.
Stomach	ESD - classical indications1	[1,4,5,13]
	mucosal adenocarcinoma; intestinal type G1 or G2, size d ≤ 2 cm, no ulcer
	ESD - expanded indications2
	adenocarcinoma, intestinal type, G1 or G2, any size without ulcer/adenocarcinoma, intestinal type, G1 or G2, sm-invasive < 500 μm/adenocarcinoma, intestinal type, G1 or G2, d ≤ 3 cm, with ulcer/adenocarcinoma diffuse type, G3 or G4, size d ≤ 2 cm, no ulcer
Esophagus	ESD - classical indications1	[5,8,9,12,14,15]
	SCC type 0-IIb (HGIN or G1, G2), intramucosal (m1, m2), any size
	Barrett adenoca. type 0-II (G1, G2), intramucosal (m1, LPM), no ulcer
	ESD - expanded indications2
	SCC type 0-II (HGIN, G1, G2) slightly invasive (m3, sm < 200 μm), any size3, clinical N 0
	Barrett adenocarcinoma type 0-II (HGIN or G1, G2), mucosal ( ≤ MM), clinical N 0
Colorectum	ESD Indications	[5,10,11,16,64]
	Any neoplasias > 20 mm in diameter without signs of deep submucosal invasion, indicative for en-bloc resection and unsuitable for EMR en-bloc:
	LST-granular type d ≥ 4 cm (villous adenoma +/- HGIN)4
	LST-nongranular type d ≥ 2 cm
	Mucosal carcinoma (HGIN, G1 or G2), or superficially sm-invasive5
	Depressed-type neoplasias (0-IIc)
	Neoplasias type 0-I or 0-II with pit pattern type VI (irregular)
	Sporadic localized neoplasias in chronic ulcerative colitis
	Colorectal carcinoids of diameter < 20 mm (EMR, when diameter < 10 mm)

¹Indications with risk of LNM < 1%;

²Indications with risk of LNM or systemic M < 4%;

³Increased risk for stricture formation, when ESD extends for ≥ 70% of circumference;

⁴LST-granular type may also be resected in piecemeal fashion, the larger nodule resected first[10];

⁵SM1 invasion of ≤ 1000 μm. LNM: Lymph node metastasis; ESD: Endoscopic submucosal dissection.