Present Status and Future Development of ESD in Hong Kong

Endoscopic submucosal dissection (ESD) is currently only available at tertiary centers in Hong Kong (HK). There are many barriers to the widespread adoption of ESD. First, the absence of a territory wide screening program results in only a small proportion of gastrointestinal neoplasms diagnosed at an early stage. Second, endoscopists working in non-tertiary centers are often not familiar with the proper use of magnifying chromoendoscopy. Finally, there is no standardized training protocol or certification by the local specialty boards and many ESD practitioners receive training from other countries.It is anticipated that the demand of ESD, particularly colorectal ESD, will dramatically increase due to the progressive rise in colorectal cancer (CRC) incidence in HK and increased awareness for CRC screening by the HK population. Furthermore, image enhanced endoscopy such as narrow band imaging has become available in many endoscopy centers and local specialty boards have begun to introduce the identification of mucosal microvascular and microsurface patterns into their training programs. The public healthcare provider (Hospital Authority) has set up a taskforce to advise on the minimum requirements for the safe practice of ESD in its institutions in terms of equipment, surgical/anaesthetic support and medical staff training and expertise. The future development of ESD will hopefully mirror the Japanese model with basic ESD available at most major institutions and difficult cases such as duodenal ESD restricted to tertiary centers.