Western perspectives on Endoscopic Submucosal Dissection for superficial gastrointestinal neoplasia

Introduction: Management of superficial neoplasia of the gastrointestinal tract differs amongst gastroenterologists. Aims: To survey current perspectives on use of endoscopic submucosal dissection (ESD) among endoscopists in the United States. Methods: A ten-question survey on management of superficial neoplasia of the gastrointestinal tract was distributed amongst gastroenterologists in the United States.Results: 31 out of 250 gastroenterologists participated (12%), 42% between the ages of 30-39 (N=13), 63% (N=19) male gender and 72% (N=21) worked in an academic hospital setting. 55% (N=16) of gastroenterologists currently performed colon endoscopic mucosal resection (EMR) and many (N=28) were cognizant of ESD. EMR (N=27) and surgical resection (N=21) were the methods most commonly used to manage superficial neoplastic lesions (either by the gastroenterologist or referral to a colleague within their institution), followed by ESD (N=15). Endoscopists trained in ESD were available in institutions of 55% gastroenterologists (N=17). Stomach and colorectum were the most frequent sites of application of ESD. Lesions containing low or high grade dysplasia and superficial (T1) carcinoma were all considered for ESD. The greatest barriers to use of ESD were the procedure being too time consuming, lack of training opportunities and poor reimbursement relative to workload.Conclusions: While ESD is a well-recognized technique for the management of superficial neoplastic lesions of the GI tract, there are significant barriers that could be addressed to better disseminate this endoscopic technique in Western endoscopy community.