Updates in the Treatment of Superficial Gastric Neoplasms by Endoscopic Submucosal Dissection
Archives of Gastroenterology Research
ESD is currently the first-line of treatment in the eradication of the pre-malignant and early malignant neoplasms, demonstrating in most studies, mainly from Asia, high rates of efficiency and safety in expert hands. This also reinforces the concept of early detection of pre-malignant and malignant lesions using virtual chromoendoscopy/endoscopic magnification techniques associated with a systematic and sequential revision, based on an endoluminal endoscopic anatomy    . For many
...  . For many years, gastrectomy has been considered the standard treatment for early gastric cancer, however it is associated with post-surgical morbidity and mortality, particularly high surgical risks patients. Japanese pioneers developed ESD as an alternative for the eradication of this type of early gastric neoplasms with great advantages over conventional surgery, as demonstrated in different comparative studies       . Liu et al.  recently reported a meta-analysis in which they included 18 studies with 5,993 patients, observing the following benefits of ESD with respect to surgery: 1) shorter duration of the procedure (128.38 min; 95%CI: (-204.68, -52.09), p=0.001); 2) shorter hospital stay (7.13 days; 95%CI: (-7.98, -6.28), p<0.00001); 3) lower risk of death associated with the procedure (OR=0.21; 95%CI: (0.07, 0.68), p=0.009); 4) lower risk of complications (OR=0.47; 95%CI: (0.34, 0.63), p<0.00001) and 5) lower costs and better quality of life. Outcomes that are corroborated with those obtained by our research group. In order to obtain a high curative rate some principles should be followed: adequate selection of patients through a thorough evaluation of the lesions using enhanced imaging endoscopic techniques Summary Gastric cancer is one of the neoplasms with the highest degree of mortality worldwide, responsible for more than 780,000 deaths in 2018 and whose incidence has been increasing over the last few years, mainly in Asian and Latin American countries. The technological imaging advances in digestive endoscopy such as virtual chromoendoscopy and magnification associated with a systematic and comprehensive endoscopic examination of the entire gastric mucosa by a trained operator have optimized the early detection of pre-malignant and malignant lesions, which have favoured the high rate of curability through the use of endoscopic resection techniques such as endoscopic submucosal dissection (ESD). ESD is one of the techniques in advanced therapeutic endoscopy that has revolutionized the management of early neoplasms of the gastrointestinal tract, demonstrating excellent results that are as equally efficient as surgery in the medium and long-term, but avoiding the post-operative morbi-mortality associated with surgical interventions and also presenting a low rate of adverse events in expert hands. This review has the objective to discuss the most recent advances in the management of superficial gastric neoplasms and to present an algorithm approach for these types of lesions.