Principles of endoscopic resection: Diagnostic and curative resection of mucosal neoplasias

Progress in endoscopic detection and analysis has set the stage for endoscopic cure of early cancers of the gastrointestinal tract. Endoscopic submucosal dissection (ESD) introduced the principle of oncosurgical en bloc resection to mucosal neoplasms providing resection R status and histological pT staging and grading. ESD aims for curative resection of mucosal cancer. The risk for local recurrence-with snare ablation in piecemeal fashion in the range of 15-35 %-is reduced close to zero after curative ESD. Accurate endoscopic analysis of mucosal neoplasias is indispensible for decision-making on ESD. Developed in Japan, ESD is now starting in Western countries. The entirely new technique imposes a learning curve on experienced interventional endoscopists with the goal to first achieve the level of competence-i.e. safety-and later the level of proficiency with rapid and safe tumour resection.