ESD around the world: Europe.

In Europe, endoscopic mucosal resection (EMR) is widely accepted as an appropriate diagnostic approach to obtain specimens for accurate histopathologic evaluation, which may change grading and local staging of early neoplasia determined by prior biopsies and imaging. In contrast to EMR, endoscopic submucosal dissection (ESD) allows resection of even large lesions in a single piece. Evidence on the clinical value of ESD is still limited and mainly based on data from Japan, and may not be directly applicable to Europe, where the outcome of ESD may be less favorable because of the limited Western expertise in this challenging technique.