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

Pedro Pimentel-Nunes; Mário Dinis-Ribeiro; Thierry Ponchon; Alessandro Repici; Michael Vieth; Antonella De Ceglie; Arnaldo Amato; Frieder Berr; Pradeep Bhandari; Andrzej Bialek; Massimo Conio; Jelle Haringsma; Cord Langner; Søren Meisner; Helmut Messmann; Mario Morino; Horst Neuhaus; Hubert Piessevaux; Massimo Rugge; Brian P. Saunders; Michel Robaszkiewicz; Stefan Seewald; Sergey Kashin; Jean-Marc Dumonceau; Cesare Hassan; Pierre H. Deprez

doi:10.1055/s-0034-1392882

Endoscopy, Table of Contents

Endoscopy 2015; 47(09): 829-854
DOI: 10.1055/s-0034-1392882

Guideline

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

Authors

Pedro Pimentel-Nunes

¹Department of Gastroenterology, Instituto Portugues de Oncologia, Porto, Portugal
Mário Dinis-Ribeiro

¹Department of Gastroenterology, Instituto Portugues de Oncologia, Porto, Portugal
Thierry Ponchon

²Department of Digestive Diseases, Hôpital Edouard Herriot, Lyon, France
Alessandro Repici

³Department of Gastroenterology, Istituto Clinico Humanitas, Milan, Italy
Michael Vieth

⁴Institute for Pathology, Klinikum Bayreuth, Bayreuth, Germany
Antonella De Ceglie

⁵Department of Gastroenterology, National Cancer Institute, Bari, Italy
Arnaldo Amato

⁶Gastroenterology Unit, Ospedale Valduce, Como, Italy
Frieder Berr

⁷University Clinic of Internal Medicine I, Salzburg, Austria
Pradeep Bhandari

⁸Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
Andrzej Bialek

⁹Pomeranian Medical University, Szczecin, Poland
Massimo Conio

¹⁰Department Gastroenterology and Endoscopy, Ospedale di Sanremo, Sanremo, Italy
Jelle Haringsma

¹¹Erasmus Medical Center, Rotterdam, The Netherlands
Cord Langner

¹²Institute of Pathology, Medizinische Universität Graz, Graz, Austria
Søren Meisner

¹³Bispebjerg Hospital, Copenhagen, Denmark
Helmut Messmann

¹⁴Department of Internal Medicine III, Klinikum Augsburg, Augsburg, Germany
Mario Morino

¹⁵Department of Surgery, University Hospital of Turin, Turin, Italy
Horst Neuhaus

¹⁶Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
Hubert Piessevaux

¹⁷Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
Massimo Rugge

¹⁸Department of Pathology, Università di Padova, Padova, Italy
Brian P. Saunders

¹⁹Wolfson Unit for Endoscopy, St. Mark’s Hospital & Imperial College, London, UK
Michel Robaszkiewicz

²⁰Service d’hépato-gastroenterologie, Hôpital de la Cavale-Blanche, Brest, France
Stefan Seewald

²¹GastroZentrum, Klinik Hirslanden, Zurich, Switzerland
Sergey Kashin

²²Endoscopy Department, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russia
Jean-Marc Dumonceau

²³Gedyt Endoscopy Center, Buenos Aires, Argentina
Cesare Hassan

²⁴Department of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy
Pierre H. Deprez

¹⁷Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium

Abstract

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).

Full Text

References

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