1. Practice of Endoscopic Mucosal Resection: A Survey to Endoscopic Units in Europe Class 15 – FMUP – 2008/2009 19 th December 2008 André Carvalho, Ana Morais, Clara Ferreira, Francisco Mourão, João Santos, José Martins, Mariana Formigo, Manuel Cruz, Raquel Santos Mário Dinis-Ribeiro, Ricardo Santos

2. BACKGROUND Gastric Cancer: - Steady decline on the incidence 1 vs - High rates of death by recurrence and progression of the disease 1 1 Roukos DH. Current advances and changes in treatment strategy may improve survival and quality of life in patients with potentially curable gastric cancer; Academic Department of Surgery, Medical School, University of Ioannina, Greece Ann Surg Oncol. 1999 Jan-Feb;6(1):46-56; Spread on the scientific interest

3. BACKGROUND Detection Stage of development Early stage Advanced stage Different approaches on the treatment

4. BACKGROUND EMR and ESD – an answer ! Japan, 1980  described in 1984 Early gastric cancer (mucosa/submucosa) Alternative to surgery!

5. BACKGROUND Advantages 2 : Less morbidity Less mortality Less invasive Posterior histological analysis Allows posterior surgery Better quality of life 2 Ahmadi A, Draganov; Endoscopic mucosal resection in the upper gastrointestinal tract. P. Division Gastroenterology Hepatology and Nutrition, University of Florida, Gainesville, Florida 32610, United States World J Gastroenterol. 2008 Apr 7;14(13):1984-9 P Disadvantages 3 : High incidence of complications Requires high endoscopy skills 3 Tanaka M, Ono H, Hasuike N; Endoscopic submucosal dissection of early gastric cancer; Takizawa K.Division of Endoscopy and Gastrointestinal Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan

6. JUSTIFICATION In Europe: <10 % of all endoscopically diagnosed gastric cancers are in an earlier stage of development 4 In Japan: 50 % of all endoscopically diagnosed gastric cancers are in an earlier stage of development 4 4 Roukos DH. Current advances and changes in treatment strategy may improve survival and quality of life in patients with potentially curable gastric cancer; Academic Department of Surgery, Medical School, University of Ioannina, Greece Ann Surg Oncol. 1999 Jan-Feb;6(1):46-56;

7. RESEARCH QUESTION What is the current use of endoscopic resection techniques (EMR/ESD) in european centers?

8. STUDY DESIGN - Observational study - cross-sectional study -

9. PARTICIPANTS Target population European endoscopic units/centers Sampling method: Non-random:  Members of the national societies of endoscopy  European centers that published papers indexed in Pubmed during 2007 and 2008 in: Gastrointestinal Endoscopy journal Endoscopy journal

10. DATA COLLECTION AND VARIABLES Online questionnaires regarding the following variables: Number and tipe of procedures Completeness of procedure Complications Type of lesions Number and expertise of operators Questionnaire will be completed and used by the participants using Medquest, developed on SBIM- FMUP.

11. GANTT CHART

14. Expected results Final product: paper with the results of the study -Earlier perspectives: -Small rates of usage -Non application due to the inexistence of enough knowledge of the techniques