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ESD, not EMR, should be the first-line therapy for early gastric neoplasia
  1. Neal Shahidi1,2,3,
  2. Michael J Bourke2,3
  1. 1 Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
  3. 3 Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
  1. Correspondence to Dr Michael J Bourke, Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW 2145, Australia; michael{at}

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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 …

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  • Contributors Drafting of the article: NS. Critical revision of the article for important intellectual content and final approval of the article: MJB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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