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Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2018; 10(10): 225-238
Published online Oct 16, 2018. doi: 10.4253/wjge.v10.i10.225
Introduction of endoscopic submucosal dissection in the West
David Friedel, Stavros Nicholas Stavropoulos
David Friedel, Stavros Nicholas Stavropoulos, Gastroenterology, NYU Winthrop Hospital, Mineola, NY 11501, United States
Author contributions: Stavropoulos SN is the source of material for this manuscript; Friedel D formulated it into this manuscript.
Conflict-of-interest statement: Dr. Friedel and Dr. Stavropoulos have nothing to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: David Friedel, MD, Associate Professor, Gastroenterology, NYU Winthrop Hospital, 222 Station Plaza North, Suite 428, Mineola, NY 11501, United States. dfriedel@winthrop.org
Telephone: +1-516-6634623 Fax: +1-516-6634617
Received: April 27, 2018
Peer-review started: April 27, 2018
First decision: May 16, 2018
Revised: July 21, 2018
Accepted: August 1, 2018
Article in press: August 1, 2018
Published online: October 16, 2018
Processing time: 172 Days and 11.1 Hours
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.