Introduction of endoscopic submucosal dissection in the West

Abstract

Endoscopic submucosal dissection (ESD) is well established in Asia as a modality for selected advanced lesions of both the upper and lower gastrointestinal tract, but ESD has not attained the same niche in the West due to a variety of reasons. These include competition from traditional surgery, minimally invasive surgery and endoscopic mucosal resection. Other obstacles to ESD introduction in the West include time commitment for learning and doing procedures, a steep learning curve, special equipment, lack of mentors, cost issues, interdisciplinary conflicts, concern regarding complications and lack of support from institutions and interfacing departments. There are intrinsic differences in pathology prevalence (e.g., early gastric cancer) between the two regions that are less conducive for ESD implementation in the West. We will elaborate on these issues and suggest measures as well as a protocol to overcome these obstacles and hopefully allow introduction of ESD as a tenable option for appropriate patients.

Keywords: Endoscopic submucosal dissection, Gastric cancer, Barrett’s esophagus, Endoscopy training, Colon cancer, Rectal cancer

Core tip: Endoscopic submucosal dissection (ESD) is a well-accepted and widely employed modality in Asia for resection of advanced mucosa-derived lesions of the gastrointestinal tract including early cancer However ESD is not widely utilized in the West for a variety of reasons including lack of mentors, steep learning curve, cost issues and concern for complications. The authors describe these obstacles to the implementation of ESD in the West and measures to overcome them and begin an ESD program. We give a Western perspective on the current status of ESD for lesions of the esophagus, stomach and colorectum.