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ESD and beyond – The benefits of “getting it early”

ESD and beyond – The benefits of “getting it early”. Dr Philip Hall Consultant Gastroenterologist Belfast City Hospital. Overview. Endoscopic resection of early cancers Benefits of getting it early Where we are currently How do you we get it early Future. What is early?.

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ESD and beyond – The benefits of “getting it early”

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  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 • 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 Equipment Technically challenging Longer procedures General anaesthesia • Remove tumour in one piece • Definitive cure endoscopically • Avoid unnecessary operations • Curative treatment for those not fit for surgery

  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?

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

  14. Cytosponge • Breath testing

  15. Now recruiting in Belfast • Saliva/blood test

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

  17. 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.

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