The next steps are learning to use the technique on animal cadavers, practicing the technique in live animals, and finally performing it on human patients. Finally, the answer to the great question about costs clearly favors ESD. Even though the accessories needed to perform the procedure are about three times more expensive than the ones used for EMR, they are also about three to five times less expensive than the cost of a gastrectomy. In addition ESD has clear advantages in endoscopic management related to quality of life, shorter hospital stays, and lower mortality rates, but has the same survival results as surgical management. This, as mentioned before, is the gold standard for dealing with early gastric cancer which all techniques have to be compared 1, 3-5. To conclude, ESD is a reality that has come to stay.
Por último, el gran interrogante de los costos está claramente a favor de la DES, pues si bien los accesorios para este procedimiento son en promedio 3 veces más costosos que los requeridos para la REM son también entre tres y cinco veces menores que los costos de una gastrectomía sin mencionar las claras ventajas del manejo endoscópico en cuanto a calidad de vida, corta hospitalización, menor morbilidad y, obviamente, con los mismos resultados en sobrevida del manejo quirúrgico que, como se expuso, es el patrón de oro para la conducción del cáncer gástrico temprano y con el que se deben comparar todas las técnicas 1, 3-5.