1. ESD and beyond – The benefits of “getting it early”
Dr Philip Hall
Consultant Gastroenterologist
Belfast City Hospital

2. Overview Endoscopic resection of early cancers Where we are currently
Benefits of getting it early
Where we are currently
How do you we get it early
Future

3. What is early?

4. Endoscopic resection (EMR)

5. European Society of Gastrointestinal Endoscopy 2015
EMR is an acceptable option for lesions smaller than 10–15mm with a very low probability of advanced histology. However, ESGE recommends ESD as treatment of choice for most gastric superficial neoplastic lesions (strong recommendation, moderate quality evidence).

6. Endoscopic Submucosal Dissection

7. Endoscopic Submucosal Dissection
Benefits
Problems
Remove tumour in one piece
Definitive cure endoscopically
Avoid unnecessary operations
Curative treatment for those not fit for surgery
Equipment
Technically challenging
Longer procedures
General anaesthesia

8. Equipment

9. Training

10. Training

11. Challenges New services General anaesthesia Nursing
Aiming to start (very) soon

12. How do you get it early Symptoms Awareness Good services/pathways
Is this early enough?

14. Getting it early
Quantity of screening Quality of screening Training, technology, ?AI Smart screening Focus on high risk groups New methods…….

15. Cytosponge
Breath testing

16. Now recruiting in Belfast
Saliva/blood test

17. HALO Registry Based in UC London
Combining data across the UK to drive improvement
EMR database

18. Summary ESD is coming – minimally invasive curative cancer resection
Getting a diagnosis early - important as ever in making the best use of this
Focus on pre-cancer and high risk groups
Non invasive screening and technology may hold the answer.