Current status of ESD in Italy

The western societies of GI endoscopy consider endosacopic submucosal dissection (ESD) as the standard technique for endoscopic resection of superficial gastric neoplasms, but its role for colorectal neoplasm is still uncertain. Moreover, the role of endoscopic resection for low-risk cancers both in the stomach and colon-rectum is still controversial in Italy due to opposing surgical guidelines.ESD in Italy is performed in few centers with few case series published in the literature. The difficulty in ESD adoption in Italy has specific causes that are common with all western countries: 1) low prevalence of easy gastric cases; 2) no experts to observe and by whom being supervised. However, these are not the only reasons why the expansion of curability of superficial GI neoplasms by by ESD is delayed. There are important topics that should be improved in the West: pit and capillary patterns should used routinely for an accurate endoscopic evaluation/staging of superficial neoplasms; endoscopic mucosal resection should be taught and practiced to the achieve the best results. An ESD stepwise training that starts from the rectum and moves to the colon is feasile in the West but the societies of GI endoscopy should take the task of this project selecting appropriate endoscopists for the highly technical demandig technique of ESD and encouraging its learning through protocols that should protect against medico-legal issues.