Bhandari et al. [1] reported the long-term outcomes of 415 gastric endoscopic submucosal dissection (ESD) cases and confirmed that the procedure is safe and effective in a Western setting. Rates of en bloc and R0 resection, and recurrence were 94.7%, 83.4%, and 2.7%, respectively. Perforation, early and delayed bleeding occurred in 2.4%, 4.3%, and 3.4%, respectively. This is the largest Western multicenter cohort but not the only one. A North American multicenter study with 347 gastric ESDs reported rates of en bloc and R0 resection, and recurrence of 92%, 82%, and 3.9%, respectively [2]. Another Italian multicenter study with 299 cases reported en bloc and R0 rates of 97.6% and 89%, respectively [3]. In Spain, the results from the national prospective registry with 230 gastric ESDs showed en bloc and R0 rates of 91.3% and 75.2%, respectively [4]. This could be explained by the fact that ESDs were performed by 30 endoscopists, many of whom were at the beginning of their learning curve. Moreover, difficult ESD (en bloc resection not achieved, hybrid resection, procedure duration >2 hours, or intraprocedural perforation) had lower R0 resection rates than ESDs not classified as difficult (64.8% and 87.6%, respectively; P = 0.000) [4].

What is new in the study by Bhandari et al. [1] is that the authors used the absolute indications for ESD published in 2021, which included the former expanded indications but without T1a undifferentiated-type adenocarcinoma of ≤2 cm without ulcerative findings. More recently, in the 6th edition of the Japanese gastric cancer treatment guidelines published in 2023 [5], only locally recurring lesions are considered as the expanded indication.

In conclusion, the implementation of gastric ESD in Western countries is a reality. To achieve similar outcomes to those in Asian countries, it should be performed by well-trained endoscopists. New studies are needed to confirm the outcomes of new absolute indications for gastric ESD outside of Japan.

Article published online:
23 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany