title: Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.
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.
  
  
  CONCLUSIONS
  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).
authors: Department of Gastroenterology, Instituto Portugues de Oncologia, Porto, Portugal.
authors: Pedro
authors: P
authors: Pimentel-Nunes
authors: Department of Gastroenterology, Instituto Portugues de Oncologia, Porto, Portugal.
authors: Mário
authors: M
authors: Dinis-Ribeiro
authors: Department of Digestive Diseases, Hôpital Edouard Herriot, Lyon, France.
authors: Thierry
authors: T
authors: Ponchon
authors: Department of Gastroenterology, Istituto Clinico Humanitas, Milan, Italy.
authors: Alessandro
authors: A
authors: Repici
authors: Institute for Pathology, Klinikum Bayreuth, Bayreuth, Germany.
authors: Michael
authors: M
authors: Vieth
authors: Department of Gastroenterology, National Cancer Institute, Bari, Italy.
authors: Antonella
authors: A
authors: De Ceglie
authors: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors: Arnaldo
authors: A
authors: Amato
authors: University Clinic of Internal Medicine I, Salzburg, Austria.
authors: Frieder
authors: F
authors: Berr
authors: Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK.
authors: Pradeep
authors: P
authors: Bhandari
authors: Pomeranian Medical University, Szczecin, Poland.
authors: Andrzej
authors: A
authors: Bialek
authors: Department Gastroenterology and Endoscopy, Ospedale di Sanremo, Sanremo, Italy.
authors: Massimo
authors: M
authors: Conio
authors: Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Jelle
authors: J
authors: Haringsma
authors: Institute of Pathology, Medizinische Universität Graz, Graz, Austria.
authors: Cord
authors: C
authors: Langner
authors: Bispebjerg Hospital, Copenhagen, Denmark.
authors: Søren
authors: S
authors: Meisner
authors: Department of Internal Medicine III, Klinikum Augsburg, Augsburg, Germany.
authors: Helmut
authors: H
authors: Messmann
authors: Department of Surgery, University Hospital of Turin, Turin, Italy.
authors: Mario
authors: M
authors: Morino
authors: Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany.
authors: Horst
authors: H
authors: Neuhaus
authors: Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium.
authors: Hubert
authors: H
authors: Piessevaux
authors: Department of Pathology, Università di Padova, Padova, Italy.
authors: Massimo
authors: M
authors: Rugge
authors: Wolfson Unit for Endoscopy, St. Mark's Hospital & Imperial College, London, UK.
authors: Brian P
authors: BP
authors: Saunders
authors: Service d'hépato-gastroenterologie, Hôpital de la Cavale-Blanche, Brest, France.
authors: Michel
authors: M
authors: Robaszkiewicz
authors: GastroZentrum, Klinik Hirslanden, Zurich, Switzerland.
authors: Stefan
authors: S
authors: Seewald
authors: Endoscopy Department, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russia.
authors: Sergey
authors: S
authors: Kashin
authors: Gedyt Endoscopy Center, Buenos Aires, Argentina.
authors: Jean-Marc
authors: JM
authors: Dumonceau
authors: Department of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy.
authors: Cesare
authors: C
authors: Hassan
authors: Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium.
authors: Pierre H
authors: PH
authors: Deprez
mesh_terms: D001471:Barrett Esophagus / Q000175:diagnosis / Q000601:surgery*; D004210:Dissection / Q000592:standards*; D016099:Endoscopy, Gastrointestinal / Q000592:standards*; D005060:Europe; D005753:Gastric Mucosa; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D018579:Patient Selection