Current status of ESD in Malaysia

ESD has consistently proven its superiority over EMR in achieving better en-bloc resection and curability of GI lesion. However this technique is still unpopular in Malaysia.In the 2007 National Cancer Statistic, colorectal carcinoma(CRC) and gastric cancer(GCA) were noted to be the second and ninth commonest cancer in Malaysia. However, most of the GCA were detected late with only 26.6% of cases detected at stage 1 or 2. Lack of early diagnosis can be attributable to the following causes that hinder early detection:1) Lack of national screening program2) Inadequate bowel preparation and endoscopic cleansing measures prior to and during the procedure3) Inadequate knowledge on the use of image-enhanced endoscopy(IEE)4) Lack of IEE-guided targeted biopsy. Specimen were mostly obtained from random forceps biopsy which may miss the actual lesionLack of popularity of ESD may be due to the fact that this technique is technically demanding and is not seen by most as beneficial when weighed against its perceived complications.1) Lack of model training(on swine and canine model) reduce the confidence level to perform ESD, let alone to deal with complications like bleeding and perforation.2) Endoscopically resected specimen were not often read in such a meticulous manner(ie 2mm cut) in order to identify clearance of both horizontal and vertical margin. This could lead to improper pathological staging and jeopardize the patient's survival