ESD, not EMR, should be the first-line therapy for early gastric neoplasia

With interest, we read the insightful recommendations by Banks et al 1 and the British Society of Gastroenterology on the management of precancerous conditions and lesions in the stomach. They rightly identify that the management of these conditions lacks consistency not only in the UK but also in the majority of Western societies.2 With a growing appreciation for quality indicators in upper GI endoscopy,3 these guidelines are an essential resource for both general endoscopists and tissue resection specialists. Nevertheless, despite the increasing expertise in endoscopic submucosal dissection (ESD) outside of Japan,4 we were surprised that endoscopic mucosal resection (EMR) was recommended for lesions ≤10 mm. This is in contrast to recommendations by the Japan Gastroenterological Endoscopy Society (JGES)5 and the European Society of Gastrointestinal Endoscopy (ESGE).6 Three systematic reviews7–9 have compared ESD versus EMR for early gastric cancer (EGC). In …