[Endoscopic submucosal dissection]

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Surgical Oncology

Context:

• Endoscopic submucosal dissection (ESD) originated in Japan and is now widely adopted in Europe.
• Traditional loop excision methods often result in incomplete removal or uncertain margins for early cancers and precancerous lesions.
• ESD enables en bloc resection of lesions larger than 1 cm, improving treatment efficacy.

Purpose:

• To provide a comprehensive review of Endoscopic submucosal dissection (ESD) applications in the upper and lower gastrointestinal tract.
• To highlight the technical aspects and advantages of ESD over conventional resection techniques.
• To discuss the current status and future perspectives of ESD in clinical practice.

Summary:

• Endoscopic submucosal dissection (ESD) involves marking, submucosal injection, and resection of gastrointestinal lesions using a specialized knife at the submucosal level.
• This technique requires advanced endoscopic skills and is more time-intensive than snare resection.
• ESD facilitates en bloc resection with clear margins, addressing limitations of previous methods for early cancers and precancerous lesions.

Impact:

• ESD demonstrates superior R0 resection rates and reduced local recurrence compared to traditional techniques.
• The procedure is crucial for managing early gastrointestinal malignancies and complex precancerous conditions.
• ESD represents a significant advancement in minimally invasive gastrointestinal treatments, offering improved patient outcomes.