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EMR achieves similar oncological outcomes as ESD for gastric neoplasia of <1cm, requiring less expertise, training and time
  1. Matthew Banks1,
  2. Noriya Uedo2,
  3. Pradeep Bhandari3,
  4. Takuji Gotoda4
  1. 1 Division of Gastroenterology, University College London Hospitals, NHS Foundation Trust, London, UK
  2. 2 Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
  3. 3 Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
  4. 4 Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
  1. Correspondence to Dr Matthew Banks, University College London Hospital, University College London Hospitals NHS Foundation Trust, London NW12PG, UK; matthew.banks2{at}

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We thank Drs Shahidi and Bourke1 for their kind interest in our British Society of Gastroenterology guidelines.2

They present a valid argument that endoscopic mucosal resection (EMR) rather than endoscopic submucosal dissection (ESD) should be the first-line therapy for all gastric neoplasia, irrespective of lesion size, location or histopathology, citing supportive evidence from the Japan Gastroenterological Endoscopy Society (JGES)3 and the European Society of Gastrointestinal Endoscopy (ESGE),4 and three systematic reviews.5–7 We accept the compelling, although low-quality evidence from the systematic reviews demonstrating that en bloc resection, R0 resection and recurrence rates favoured ESD overall.

Although the JGES guidelines state that ESD is better than EMR, they provide the caveat that there have been no randomised controlled trials examining the therapeutic results between EMR and ESD in …

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  • Contributors All authors contributed equally to the letter.

  • 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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