Why can ESD be considered before surgery for selected early GI lesions?

For early gastrointestinal lesions, the key question is not simply “endoscopy or surgery?” The probability that disease is confined to superficial layers, lymph-node risk and the likelihood of complete endoscopic removal are assessed first.

In suitable lesions, ESD can remove a large area in one piece, giving pathology a specimen that allows detailed assessment of margins and depth of invasion. This information helps determine whether endoscopic treatment is sufficient.

Not every dysplastic lesion or early cancer is appropriate for ESD. Suspected deep invasion, meaningful nodal risk or inability to remove the lesion safely may favour surgery. High-quality endoscopic imaging and staging are therefore essential before treatment.

The final step after ESD is pathology review. Margins, invasion depth, lymphovascular involvement and histologic features guide the need for any additional treatment.