"Endoscopic submucosal dissection: a critical appraisal of its role in Western endoscopy practice"

Endoscopic submucosal dissection (ESD) was developed in Japan, early in this century, to provide a minimally invasive yet curative treatment for the large numbers of patients with early gastric cancer identified by the national screening program. Previously the majority of these patients were treated surgically at substantial cost with the significant risk of short and long-term morbidity. Enbloc excision of these early cancers, most with a limited risk of nodal metastasis, allowed complete staging of the tumor, stratification of the subsequent therapeutic approach and potential cure. This transformative innovation changed the nature of endoscopic treatment for superficial mucosal neoplasia and ultimately, for the first time, allowed endoscopists to assert that the early cancer had been definitively cured. Subsequently western endoscopists have increasingly embraced the therapeutic possibilities offered by ESD, but with some justifiable scientific caution. Herein we provide an evidence based critical appraisal of the role of ESD in advanced endoscopic tissue resectio