Dear Collegues

we invite you to improve your skills in endoscopic analysis, therapeutic indication and endoscopic resection of early GI neoplasias, and to inform you about CME events on EC and ESD of the GI tract.

Early Gastrointestinal Cancer (EC)

The term has been coined in Japan for carcinoma curable with resection (5 yr DFS >95%), and step-wise classified with endoscopic macroscopic, microsurface and microvascular criteria, and histologic criteria (pT≤1b, G1-2, N0). Endoscopic detection of EC & precursor neoplasias - often very small - is crucial for curative resection. Endoscopic analysis of EC provides accurate differential indication for resection technique (RT) – i.e. endoscopic submucosal dissection (ESD) or surgery with lymphadenectomy (SR & LNE).

En bloc resection

is the indispensable principle of surgery for cancer in curative intention. This principle has been adopted with endoscopic submucosal dissection (ESD) and validated by Japan Gastroenterological Endoscopy Society (JGES). Consequently, some Western guidelines have adopted the principle of endoscopic en bloc resection of malignant appearing GI neoplasias, whereas others still adhere to piecemeal snaring for early cancer in Barrett´s esophagus or colorectum. A supply network of referral centers has implemented ESD as low risk technique in Europe since 2009 (ref1), but the rates of histologic curative resection (CR) lag minus 15% to 20% behind professional centers in Japan (ref2-4). This mainly is due to poor endoscopic prediction of submucosal invasion and inaccurate delineation of lateral margins or multiple foci (ref2).

AIMS

• Endoscopic detection of pre-/malignant neoplasias in the earliest stage,
• Predict tumor category and grading with high accuracy (>90%), and
• Make the indication for the least invasive curative resection technique,
• Endoscopic electrosurgical performance of ESD in Early Cancer Centers on Japanese benchmark levels (curative resection rate >80%, AE <5%, recurrence <3%).