Status of ESD in Australia

Although Endoscopic Submucosal Dissection (ESD) has been practiced for close to 2 decades, the first ESD was only performed in Australia in 2008. However, over the last 4 years, there has been a steady rise in the number of procedures with 21 cases performed in 2011, 23 in 2012, 36 in 2013 and 33, upto May 2014. The development and uptake have been slow and cautious. The primary reason for this is the lack of suitable cases, which results in lack of familiarity with the technique and insufficient caseload to maintain competency. Dysplasia in Barrett's Oesophagus and early colorectal neoplasia, which are more common, are normally dealt by Endoscopic Mucosal Resection (EMR) which have yielded excellent long-term results. There is also probably an (over) emphasis on high turnover in routine diagnostic endoscopy. The procedure is done to explain the symptoms rather than a systematic and careful interrogation to look for endoscopic features of early neoplasia. In the author's opinion, in the West, in addition to Early Gastric Cancers, ESD may have an 'expanded role' for resection of suitable colorectal polyps for: i) polyps which have been endoscopically attempted in the past, ii) lesions which have a suspicion of superficial cancer based on advanced endoscopic imaging modalities or iii) non granular lesions which could have a higher incidence of invasive cancer.