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Updated: Feb 13, 2026

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Endoscopic Submucosal Dissection: Indications and Application in Western Endoscopy Practice.

Michael J Bourke1, Horst Neuhaus2, Jacques J Bergman3

  • 1Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.

Gastroenterology
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PubMed
Summary

Endoscopic submucosal dissection (ESD) offers a minimally invasive, curative treatment for early gastric cancer, replacing traditional surgery. This technique enables precise tumor removal, staging, and definitive cure for superficial neoplasia.

Keywords:
Endoscopic Mucosal ResectionEndoscopic Submucosal DissectionGastric CancerPolypectomy

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Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Oncology

Background:

  • Early gastric cancer detection increased due to national screening programs in Japan.
  • Traditional surgical treatment posed significant morbidity risks and costs.
  • Endoscopic submucosal dissection (ESD) emerged as a minimally invasive alternative.

Purpose of the Study:

  • To critically appraise the role of ESD in advanced endoscopic tissue resection.
  • To evaluate ESD's efficacy and safety compared to conventional surgery for early gastric cancer.
  • To provide an evidence-based review for Western endoscopists adopting ESD.

Main Methods:

  • Review of evidence-based literature on ESD for early gastric cancer.
  • Comparative analysis of ESD outcomes versus surgical resection.
  • Assessment of ESD's impact on staging and therapeutic stratification.

Main Results:

  • ESD allows en-bloc excision of early gastric cancers with curative potential.
  • The technique facilitates complete tumor staging and risk stratification.
  • ESD has transformed endoscopic treatment for superficial neoplasia, offering definitive cure.

Conclusions:

  • Endoscopic submucosal dissection is a transformative innovation for early gastric cancer treatment.
  • ESD provides a minimally invasive, curative option with reduced morbidity compared to surgery.
  • Western adoption of ESD is increasing, supported by growing evidence.