Endoscopy 2015; 47(09): 829-854
DOI: 10.1055/s-0034-1392882
Guideline
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Pedro Pimentel-Nunes
1  Department of Gastroenterology, Instituto Portugues de Oncologia, Porto, Portugal
,
Mário Dinis-Ribeiro
1  Department of Gastroenterology, Instituto Portugues de Oncologia, Porto, Portugal
,
Thierry Ponchon
2  Department of Digestive Diseases, Hôpital Edouard Herriot, Lyon, France
,
Alessandro Repici
3  Department of Gastroenterology, Istituto Clinico Humanitas, Milan, Italy
,
Michael Vieth
4  Institute for Pathology, Klinikum Bayreuth, Bayreuth, Germany
,
Antonella De Ceglie
5  Department of Gastroenterology, National Cancer Institute, Bari, Italy
,
Arnaldo Amato
6  Gastroenterology Unit, Ospedale Valduce, Como, Italy
,
Frieder Berr
7  University Clinic of Internal Medicine I, Salzburg, Austria
,
Pradeep Bhandari
8  Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
,
Andrzej Bialek
9  Pomeranian Medical University, Szczecin, Poland
,
Massimo Conio
10  Department Gastroenterology and Endoscopy, Ospedale di Sanremo, Sanremo, Italy
,
Jelle Haringsma
11  Erasmus Medical Center, Rotterdam, The Netherlands
,
Cord Langner
12  Institute of Pathology, Medizinische Universität Graz, Graz, Austria
,
Søren Meisner
13  Bispebjerg Hospital, Copenhagen, Denmark
,
Helmut Messmann
14  Department of Internal Medicine III, Klinikum Augsburg, Augsburg, Germany
,
Mario Morino
15  Department of Surgery, University Hospital of Turin, Turin, Italy
,
Horst Neuhaus
16  Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
,
Hubert Piessevaux
17  Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
,
Massimo Rugge
18  Department of Pathology, Università di Padova, Padova, Italy
,
Brian P. Saunders
19  Wolfson Unit for Endoscopy, St. Mark’s Hospital & Imperial College, London, UK
,
Michel Robaszkiewicz
20  Service d’hépato-gastroenterologie, Hôpital de la Cavale-Blanche, Brest, France
,
Stefan Seewald
21  GastroZentrum, Klinik Hirslanden, Zurich, Switzerland
,
Sergey Kashin
22  Endoscopy Department, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russia
,
Jean-Marc Dumonceau
23  Gedyt Endoscopy Center, Buenos Aires, Argentina
,
Cesare Hassan
24  Department of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy
,
Pierre H. Deprez
17  Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
› Author Affiliations
Further Information

Publication History

Publication Date:
28 August 2015 (online)

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system [1] [2] was adopted to define the strength of recommendations and the quality of evidence.

Main recommendations

1 ESGE recommends endoscopic en bloc resection for superficial esophageal squamous cell cancers (SCCs), excluding those with obvious submucosal involvement (strong recommendation, moderate quality evidence). Endoscopic mucosal resection (EMR) may be considered in such lesions when they are smaller than 10 mm if en bloc resection can be assured. However, ESGE recommends endoscopic submucosal dissection (ESD) as the first option, mainly to provide an en bloc resection with accurate pathology staging and to avoid missing important histological features (strong recommendation, moderate quality evidence).

2 ESGE recommends endoscopic resection with a curative intent for visible lesions in Barrett’s esophagus (strong recommendation, moderate quality evidence). ESD has not been shown to be superior to EMR for excision of mucosal cancer, and for that reason EMR should be preferred. ESD may be considered in selected cases, such as lesions larger than 15 mm, poorly lifting tumors, and lesions at risk for submucosal invasion (strong recommendation, moderate quality evidence).

3 ESGE recommends endoscopic resection for the treatment of gastric superficial neoplastic lesions that possess a very low risk of lymph node metastasis (strong recommendation, high quality evidence). EMR is an acceptable option for lesions smaller than 10 – 15 mm with a very low probability of advanced histology (Paris 0-IIa). However, ESGE recommends ESD as treatment of choice for most gastric superficial neoplastic lesions (strong recommendation, moderate quality evidence).

4 ESGE states that the majority of colonic and rectal superficial lesions can be effectively removed in a curative way by standard polypectomy and/or by EMR (strong recommendation, moderate quality evidence). ESD can be considered for removal of colonic and rectal lesions with high suspicion of limited submucosal invasion that is based on two main criteria of depressed morphology and irregular or nongranular surface pattern, particularly if the lesions are larger than 20 mm; or ESD can be considered for colorectal lesions that otherwise cannot be optimally and radically removed by snare-based techniques (strong recommendation, moderate quality evidence).