Ten quality indicators for endoscopic submucosal dissection: what should be monitored and reported to improve quality.

In the last decade, endoscopic submucosal dissection (ESD) has become more popular in Asia and, more recently, also in Europe and North America, however the issue of quality control has never been raised. Therefore, there is an urgent need to identify possible quality indicators to monitor as part of internal audit process. This is particularly compelling, since the diffusion of ESD outside Asian, super-expert, high-volume, tertiary referral centers. In the current review, we raised the issue of quality control for ESD and proposed a list of ten possible quality indicators that should be monitored by each endoscopist and reported in every study reporting results on ESD procedures. We feel that these quality indicators should be used in clinical practice by endoscopists to benchmark the data with the internationally recommended standards.