Endoscopic submucosal dissection of gastric lesions

Current evidence on the safety and efficacy of endoscopic submucosal dissection (ESD) of gastric lesions shows that it is efficacious in achieving complete resection in a high proportion of cases, but evidence of long-term survival following treatment of malignant lesions is limited in quantity. There are safety concerns regarding the risks of perforation and bleeding. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.

Clinicians wishing to undertake ESD of gastric lesions should take the following actions.

• Inform the clinical governance leads in their Trusts.

• Ensure that patients understand the uncertainty about the procedure's efficacy in relation to treating malignant lesions; and the risks of perforation, bleeding, and possible conversion to open surgery. Patients should be provided with clear written information. In addition, the use of NICE's information for the public is recommended.

• Audit and review clinical outcomes of all patients having ESD of gastric lesions (see section 3.1).

Patient selection should be carried out by an upper gastrointestinal cancer multidisciplinary team.

This is a technically challenging procedure and should only be carried out by clinicians with specific training in the technique. The Joint Advisory Group on Gastrointestinal Endoscopy intends to prepare training standards for this procedure.

NICE encourages further research into ESD of gastric lesions. There should be clear documentation of the incidence of complications, including perforation, bleeding and the need for open surgery (with the reasons for this), rates of complete resection, and long-term outcomes, including local recurrence and survival following treatment of malignant lesions.