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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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