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Endoscopy 2010; 42(10): 853-858
DOI: 10.1055/s-0030-1255563
Review

© Georg Thieme Verlag KG Stuttgart · New York

Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts

P.  H.  Deprez1 , J.  J.  Bergman2 , S.  Meisner3 , T.  Ponchon4 , A.  Repici5 , M.  Dinis-Ribeiro6 , J.  Haringsma7
  • 1Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
  • 2Academic Medical Centre, Department of Gastroenterology and Hepatology, Amsterdam, The Netherlands
  • 3Endoscopy Unit, Bispebjerg Hospital, Copenhagen, Denmark
  • 4PAM Spécialités Chirurgicales, Hôpital E. Herriot, Lyon, France
  • 5Digestive Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Milano, Italy
  • 6Portuguese Oncology Center Porto, CINTESIS / Porto Faculty of Medicine, Portugal
  • 7Erasmus MC, Rotterdam, The Netherlands
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Publication History

Publication Date:
09 July 2010 (online)

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Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of expertsEndoscopy 2010; 42(10): E360-E360
DOI: 10.1055/s-0030-1255827

Endoscopic submucosal dissection (ESD) is the gold standard technique for performing en bloc resection of large superficial tumors in the upper and lower gastrointestinal tract. Experience in Europe, however, is still limited and ESD is only performed in a few selected centers, with low volumes of cases, no description of training programs, and few published reports. In 2008, a panel of experts gathered in Rotterdam to discuss indications, training, and the wider use of ESD. The panel of experts and participants reached a consensus on five general statements: 1) ESD aims at treating mucosal cancer; 2) treatment aims for R0 resection; 3) ESD should meet quality standards; 4) ESD should be performed following national or European Society of Gastrointestinal Endoscopy (ESGE) guidelines or under institutional review board approval; and 5) ESD cases should be registered. Due to the high level of expertise needed to perform the technique safely, ESD should be performed in a step-up approach, starting with lesions presenting in the rectum or in the distal stomach, then colon, proximal stomach, and finally in the esophagus. Registration is advised either at the local site or at a national or ESGE level, and should include information on indication (Paris classification of lesion, location, and histological results prior to treatment), technique used (e. g. type of knife), results (en bloc and R0 resection), complications, and follow-up. The panel also agreed on minimal institutional requirements: good quality imaging, experienced histopathologist following the Japanese criteria (2-mm sections, micrometric invasion, vessel and lymphatic infiltration, etc), and dedicated endoscopic follow-up. Moreover, minimum training requirements were also defined: knowledge in indications and instruments, exposure to experts (currently all in Japan), hands-on experience in a model of isolated pig stomach and in live pigs, and management of complications. The experts did not reach a consensus on a minimum case load, or whether the technique should be restricted to expert centers.

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P. H. DeprezMD, PhD 

Gastroenterology
Cliniques Universitaires Saint-Luc

Av. Hippocrate 10
B-1200 Brussels, Belgium

Fax: +32-2-7648927

Email: pdeprez@uclouvain.be

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