Endoscopic Submucosal Dissection in the Treatment of Gastrointestinal Superficial Lesions: Follow the Guidelines!

he detection of early gastrointestinal neoplastic lesions ommonly known as superficial lesions is increasing.1 Even hough current oncological Western guidelines still consider urgery as the gold standard of treatment, endoscopic resecion can cure a substantial number of these patients. In fact apanese Cancer guidelines consider endoscopic approach s the preferred approach for these lesions, as long as they re considered endoscopically resectable.2 The main reaon for this is that endoscopic treatment is considered less nvasive and potentially less disturbing of the quality of ife of the patients when compared to alternative treatents. Moreover, several and large Eastern series as well as ecent Western series confirm these aspects showing that, n fact, endoscopic resection can cure more than 80--85% f these lesions and that in the worse scenario the endocopic resected specimen can be the best staging tool of he neoplasia with a good safety profile.3 Endoscopic resection of superficial lesions was initially erformed by different techniques of endoscopic mucosal esection (EMR). However, it was soon apparent that EMR ould not achieve en bloc complete resection (R0) of lesions arger than 15--20 mm or nonlifting lesions.3 This can hamer a correct histopathological evaluation of the neoplasia, ot allowing a complete assumption of a curative resection nd in some cases it could send to surgery some patients