Final survey 0.1 E-Mail 0.2 Does your answer reflect your own practice or your department's?

Stomach Stomach ESD: general data 1. Do you perform ESD in the stomach?  1.1. Which year was gastric ESD introduced in your practice/department?  1.2. How many cases of superficial gastric lesions were treated by ESD last year (2016)?  1.3. How many cases of superficial gastric lesions were treated by ESD ever?

Stomach ESD: pre-procedure  1.4. Which exams do you perform before ESD?    (a) I don't perform either radiologic or endosonographic exams before ESD    (b) CT scan    (c) EUS    (d) Both

Stomach ESD: procedure  1.5. What was the proportion of cases (%) scheduled for ESD in which ESD was performed (feasibility)?

1.6. Which of the following techniques is currently your preferred, for gastric ESD?    (a) Total circumferential before submucosal dissection    (b) Partial circumferential before submucosal dissection    (c) Submucosal tunneling    (d) Other

1.7. As far as INCISION is concerned, which kind of knife is mostly used?    (a) Needle knife    (b) Flex knife    (c) Hook knife    (d) Flush knife    (e) Hybrid knife    (f) Dual knife    (g) IT knife    (h) IT2 knife    (i) Other

1.8. As far as CIRCUMFERENTIAL DISSECTION/ MUCOSAL DISSECTION is concerned, which kind of knife is mostly used?    (a) Needle knife    (b) Flex knife    (c) Hook knife    (d) Flush knife    (e) Hybrid knife    (f) Dual knife    (g) IT knife    (h) IT2 knife    (i) Other

1.9. Which submucosal injection solution do you usually use (e.g., saline with methylene blue)?

1.10.   1.10.1. What was the proportion of cases (%) resected in CARDIA?   1.10.2. What was the proportion of cases (%) resected in the FUNDUS?   1.10.3. What was the proportion of cases (%) resected in GASTRIC BODY?   1.10.4. What was the proportion of cases (%) resected in INCISURA?   1.10.5. What was the proportion of cases (%) resected in ANTRUM?

1.11.   1.11.1. Please estimate the percentage (%) of lesion classified as I:   1.11.2. Please estimate the percentage (%) of lesion classified as II (accept IIc + IIa; etc.):   1.11.3. Please estimate the percentage (%) of lesion classified as III:   1.11.4. Please estimate the percentage (%) of lesion classified as a scar:

1.12.   1.12.1. What was the MINIMUM diameter of lesions resected?   1.12.2. What was the MAXIMUM diameter of lesions resected?   1.12.3. What was the proportion of cases >20 mm (%)?   1.13.1. What was the proportion of cases (%) with EN BLOC RESECTION (tumor was resected in one piece)?

1.14. What strategies do you routinely use for prevention of post-ESD hemorrhage? (possible to select >1)    (a) Coagulation of visible vessels with ESD-knife    (b) Coagulation of visible vessels with hemostatic forceps    (c) Clipping of visible vessels    (d) Other

Stomach ESD: post-procedure 1.15. Do you routinely perform second-look endoscopy?   1.15.1. If yes, how many hours after ESD?

1.16.   1.16.1 What is the acid suppression strategy after ESD? (free text)   1.16.2. In the absence of complications, how many days after ESD does oral feeding start?   1.16.3. What is the routine period of inpatient surveillance after ESD (in days)?   1.16.4. What was the proportion of cases (%) with frank perforation (visible perforation during procedure)?   1.16.5. What was the proportion of cases (%) with micro perforation (free air on X-ray/CT without visible perforation during procedure)?   1.16.6. What was the proportion of cases (%) with major acute bleeding during procedure (massive bleeding requiring transfusing or modification of endoscopic procedure)?   1.16.7. What was the proportion of cases (%) with delayed bleeding (decrease of Hb 2 g/dL, transfusion or endoscopic/surgical procedure because hematemesis or melena in the postoperative period)?   1.16.8. What was the proportion of cases (%) that were submitted to surgery because of complications?   1.16.9. If others, please specify (description and number):

1.17.   1.17.1. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with low grade intraepithelial neoplasia?   1.17.2. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with high grade intraepithelial neoplasia?   1.17.3. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with intramucosal adenocarcinoma?   1.17.4. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with adenocarcinoma with superficial submucosal invasion (pT1b sm1)?   1.17.5. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with adenocarcinoma with deep submucosal invasion (pT1b > sm1)?

1.18.   1.18.1. Regarding the completeness of resection/histological assessment, what was the proportion of cases (%) with R0 (lateral and vertical margins were free of tumor)?   1.18.2. Regarding the completeness of resection/histological assessment, what was the proportion of cases (%) with R1 (tumor extends into margins)?   1.18.3. Regarding the completeness of resection/histological assessment, what was the proportion of cases (%) with Rx (not possible to define - coagulation effects/piecemeal resection)?   1.18.4. According to ESGE Endoscopic Submucosal Dissection guidelines, what is the proportion (%) of non-curative cases?

Stomach ESD: follow-up  1.19.   1.19.1. Which exams do you perform in cases of curative criteria? (select more than one if applicable)     (a) I don't perform radiological exams     (b) Chest CT     (c) Abdominal CT     (d) Pelvic CT     (e) PET scan     (f) Endoscopic ultrasound   1.19.2. What is the follow-up interval between radiological exams (in years)?

1.20. 1.20.1. At follow-up, what is the proportion of cases (%) with local recurrence (neoplastic lesion at the same site after procedure)? 1.20.2. At follow-up, what is the proportion of cases (%) with metachronous recurrence (neoplastic lesion at a different site)?

Stomach ESD: complications  1.21.   1.21.1. How many patients were submitted to surgery despite ESD, for complications?   1.12.2. How many patients were submitted to surgery despite ESD due to non-curative resection?

Duodenum Duodenum ESD: general data 2. Do you perform ESD in duodenum?

Esophagus Esophagus ESD: general data 3. Do you perform ESD in esophagus?  3.1. Which year was esophageal ESD introduced in your practice/department?  3.2. How many cases of superficial esophageal lesions were treated by ESD last year (2016)?  3.3. How many cases of superficial esophageal lesions were treated by ESD ever?

Esophagusm ESD: pre-procedure  3.4. Which exams do you perform before ESD?    (a) I don't perform either radiologic or endosonographic exams before ESD    (b) CT scan    (c) EUS    (d) Both

Esophagus: procedure  3.5. What was the proportion of cases (%) scheduled for ESD in which ESD was performed (feasibility)?

3.6. Which of the following techniques is currently your preferred, for esophageal ESD?    (a) Total circumferential before submucosal dissection    (b) Partial circumferential before submucosal dissection    (c) Submucosal tunneling    (d) Other

3.7. As far as INCISION is concerned, which kind of knife is mostly used?    (a) Needle knife    (b) Flex knife    (c) Hook knife    (d) Flush knife    (e) Hybrid knife    (f) Dual knife    (g) IT knife    (h) IT2 knife    (i) Other

3.8. As far as CIRCUMFERENTIAL DISSECTION/ SUBMUCOSAL DISSECTION is concerned, which kind of knife is mostly used?    (a) Needle knife    (b) Flex knife    (c) Hook knife    (d) Flush knife    (e) Hybrid knife    (f) Dual knife    (g) IT knife    (h) IT2 knife    (i) Other

3.9. Which submucosal injection solution do you usually use (e.g., saline with methylene blue)?

3.10.   3.10.1. What was the proportion of cases (%) resected with squamous cell lesion?   3.10.2. What was the proportion of cases (%) resected with Barrett lesion?

3.11.   3.11.1. Please estimate the percentage (%) of lesion classified as I:   3.11.2. Please estimate the percentage (%) of lesion classified as II (accept IIc + IIa; etc.):   3.11.3. Please estimate the percentage (%) of lesion classified as III:   3.11.4. Please estimate the percentage (%) of lesion classified as a scar:

3.12.   3.12.1. What was the MINIMUM diameter of lesions resected?   3.12.2. What was the MAXIMUM diameter of lesions resected?   3.12.3. What was the proportion of cases >20 mm (%)?

3.13.   3.13.1. What was the proportion of cases (%) with EN BLOC RESECTION (tumor was resected in one piece)?

3.14. What strategies do your routinely use for prevention of post-ESD hemorrhage? (possible to select more than one)    (a) Coagulation of visible vessels with ESD-knife    (b) Coagulation of visible vessels with hemostatic forceps    (c) Clipping of visible vessels    (d) Other

Esophagus: post-procedure  3.15. Do you routinely perform second-look endoscopy?  3.15.1. If yes, how many hours after ESD?

3.16.   3.16.1. What is the acid suppression strategy after ESD? (free text)   3.16.2. In the absence of complications, how many days after ESD does oral feeding start?   3.16.3. What is the routine period of inpatient surveillance after ESD (in days)?

3.17.   3.17.1. What was the proportion of cases (%) with frank perforation (visible perforation during procedure)?   3.17.2. What was the proportion of cases (%) with micro perforation (free air on X-ray/CT without visible perforation during procedure)?   3.17.3. What was the proportion of cases (%) with major acute bleeding during procedure (massive bleeding requiring transfusing or modification of endoscopic procedure)?   3.17.4. What was the proportion of cases (%) with delayed bleeding (decrease of Hb 2 g/dL, transfusion or endoscopic/surgical procedure because hematemesis or melena in the postoperative period)?   3.17.5. What was the proportion of cases (%) that were submitted to surgery because of complications?   3.17.6. If others, please specify (description and number):

3.18.  Barret lesion   3.18.1. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with low grade intraepithelial neoplasia?   3.18.2. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with high grade intraepithelial neoplasia?   3.18.3. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with intramucosal adenocarcinoma?   3.18.4. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with adenocarcinoma with superficial submucosal invasion (pT1b sm1)?   3.18.5. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with adenocarcinoma with deep submucosal invasion (pT1b > sm1)?

Squamous cell lesion   3.18.6. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with low grade squamous dysplasia?   3.18.7. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with high grade squamous dysplasia?   3.18.8. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with intramucosal squamous cell carcinoma?   3.18.9. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with submucosal squamous cell carcinoma?

3.19.   3.19.1. Regarding the completeness of resection/histological assessment, what was the proportion of cases (%) with R0 (lateral and vertical margins were free of tumor)?   3.19.2. Regarding the completeness of resection/histological assessment, what was the proportion of cases (%) with R1 (tumor extends into margins)?   3.19.3. Regarding the completeness of resection/histological assessment, what was the proportion of cases (%) with Rx (not possible to define - coagulation effects/piecemeal resection)?   3.19.4. According to ESGE Endoscopic Submucosal Dissection guidelines, what is the proportion (%) of non-curative cases?

Esophagus ESD: follow-up  3.20.   3.20.1. Which exams do you perform in cases of curative criteria? (select more than one if applicable)    (a) I don't perform radiological exams    (b) Chest CT    (c) Abdominal CT    (d) Pelvic CT    (e) PET scan    (f) Endoscopic ultrasound   3.20.2. What is the follow-up interval between radiological exams (in years)?

3.21.   3.21.1. At follow-up, what is the proportion of cases (%) with local recurrence (neoplastic lesion at the same site after procedure)?   3.21.2. At follow-up, what is the proportion of cases (%) with metachronous recurrence (neoplastic lesion at a different site)?

3.22. How many patients were submitted to additional treatment (surgery, chemotherapy, radiotherapy) despite ESD?

Colon and rectum Colon and rectum ESD: general data 4. Do you perform ESD in colon and rectum?  4.1. Which year was colon and rectum ESD introduced in your practice/department?  4.2. How many cases of superficial colon and rectum lesions were treated by ESD last year (2016)?  4.3. How many cases of superficial colon and rectum lesions were treated by ESD ever?

Colon and rectum ESD: pre-procedure  4.4. Which exams do you perform before ESD?    (a) I don't perform either radiological or endosonographic exams before ESD    (b) CT scan    (c) EUS    (d) Both

Colon and rectum ESD: procedure  4.5. What was the proportion of cases (%) scheduled for ESD in which ESD was performed (feasibility)?

4.6. Which of the following techniques is currently preferred, for colon-rectum ESD?    (a) Total circumferential before submucosal dissection    (b) Partial circumferential before submucosal dissection    (c) Submucosal tunneling    (d) Other

4.7. As far as INCISION is concerned, which kind of knife is mostly used?    (a) Needle knife    (b) Flex knife    (c) Hook knife    (d) Flush knife    (e) Hybrid knife    (f) Dual knife    (g) IT knife    (h) IT2 knife    (i) Other

4.8. As far as CIRCUMFERENTIAL DISSECTION/ SUBMUCOSAL DISSECTION is concerned, which kind of knife is mostly used?    (a) Needle knife    (b) Flex knife    (c) Hook knife    (d) Flush knife    (e) Hybrid knife    (f) Dual knife    (g) IT knife    (h) IT2 knife    (i) Other

4.9. Which submucosal injection solution do you usually use (e.g., saline with methylene blue)?

4.10.   4.10.1. What was the proportion of cases (%) resected in RECTUM?   4.10.2. What was the proportion of cases (%) resected in SIGMOID/ DESCENDING COLON?   4.10.3. What was the proportion of cases (%) resected in TRANSVERSE COLON?   4.10.4. What was the proportion of cases (%) resected in ASCENDING COLON?

4.11.   4.11.1. Please estimate the percentage (%) of lesion classified as I:   4.11.2. Please estimate the percentage (%) of lesion classified as II (accept IIc + IIa; etc.):   4.11.3. Please estimate the percentage (%) of lesion classified as III:   4.11.4. Please estimate the percentage (%) of lesion classified as a scar:

4.12.   4.12.1. What was the MINIMUM diameter of lesions resected?   4.12.2. What was the MAXIMUM diameter of lesions resected?   4.12.3. What was the proportion of cases >20 mm (%)?

4.13.   4.13.1. What was the proportion of cases (%) with EN BLOC RESECTION (tumor was resected in one piece)?

4.14. What strategies do your routinely use for prevention of post-ESD hemorrhage? (possible to select >1)    (a) Coagulation of visible vessels with ESD-knife    (b) Coagulation of visible vessels with hemostatic forceps    (c) Clipping of visible vessels    (d) Other

Colon and rectum: post-procedure  4.15. Do you routinely perform second-look endoscopy?   4.15.1. If yes, how many hours after ESD?

4.16.   4.16.1. Do you prescribe antibiotics after ESD?   4.16.2. In the absence of complications, how many days after ESD does oral feeding start?   4.16.3. What is the routine period of inpatient surveillance after ESD (in days)?

4.17.   4.17.1. What was the proportion of cases (%) with frank perforation (visible perforation during procedure)?   4.17.2. What was the proportion of cases (%) with micro perforation (free air on X-ray/CT without visible perforation during procedure)?   4.17.3. What was the proportion of cases (%) with major acute bleeding during procedure (massive bleeding requiring transfusing or modification of endoscopic procedure)?   4.17.4. What was the proportion of cases (%) with delayed bleeding (decrease of Hb 2g/dL, transfusion or endoscopic/surgical procedure because hematochezia in the postoperative period)?   4.17.5. What was the proportion of cases (%) that were submitted to surgery because of complications?   4.17.6. If others, please specify (description and number)

4.18.   4.18.1. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with low grade intraepithelial neoplasia?   4.18.2. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with high grade intraepithelial neoplasia?   4.18.3. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with intramucosal adenocarcinoma?   4.18.4. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with adenocarcinoma with superficial submucosal invasion (pT1b sm1)?   4.18.5. Regarding the post resection histology of the lesion, what was the proportion of cases (%) with adenocarcinoma with deep submucosal invasion (pT1b > sm1)?

4.19.   4.19.1. Regarding the completeness of resection/histological assessment, what was the proportion of cases (%) with R0 (lateral and vertical margins were free of tumor)?   4.19.2. Regarding the completeness of resection/histological assessment, what was the proportion of cases (%) with R1 (tumor extend into margins)?   4.19.3. Regarding the completeness of resection/histological assessment, what was the proportion of cases (%) with Rx (not possible to define - coagulation effects/piecemeal resection)?   4.19.4. According to ESGE Endoscopic Submucosal Dissection guidelines, what is the proportion (%) of non curative cases?

Colon and rectum: follow-up  4.20.   4.20.1. Which exams do you perform in cases of curative criteria? (select more than one if applicable)    (a) I don't perform radiological exams    (b) Chest CT    (c) Abdominal CT    (d) Pelvic CT    (e) PET scan    (f) Endoscopic ultrasound   4.20.2. What is the follow-up interval between radiological exams (in years)?

4.21.   4.21.1. At follow-up, what is the proportion of cases (%) with local recurrence (neoplastic lesion at the same site after procedure)?   4.21.2. At follow-up, what is the proportion of cases (%) with metachronous lesion?

4.22.   4.22.1. How many patients were submitted to surgery despite ESD, for complications?   4.22.2. How many patients were submitted to surgery despite ESD due to non-curative resection?