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Drug-targeted endoscopic submucosal dissection: a hypothetical framework toward non-electromechanical mucosal
Conghua Song1, Huiyuan Xu2, Xiaomei Li2,3
1Gastrointestinal Endoscopy Center, The Affiliated Hospital of Putian University, Putian, Fujian, China.
Frontiers in Medicine
|December 11, 2025
Summary
Drug-targeted endoscopic submucosal dissection (DT-ESD) proposes using enzymes to aid submucosal separation, potentially reducing time and complexity. This innovative approach aims to improve endoscopic resection of gastrointestinal neoplasms.
Area of Science:
- Gastroenterology
- Endoscopic Therapy
- Minimally Invasive Surgery
Background:
- Endoscopic submucosal dissection (ESD) is standard for gastrointestinal neoplasm resection.
- ESD is technically demanding, time-consuming, and carries risks like perforation and bleeding due to electromechanical methods.
Purpose of the Study:
- To introduce a theoretical concept for drug-targeted endoscopic submucosal dissection (DT-ESD).
- To explore replacing mechanical dissection with localized chemical degradation of the submucosa.
Main Methods:
- Conceptualizing DT-ESD, preserving most conventional ESD steps.
- Incorporating selective enzymatic digestion for submucosal separation.
- Detailing conceptual workflow, candidate agents, and delivery strategy.
Main Results:
- DT-ESD theoretically reduces procedure time, thermal injury, and technical complexity.
- The approach offers a potential paradigm shift in endoscopic therapy.
Conclusions:
- DT-ESD is a theoretical concept requiring validation in ex vivo and in vivo models.
- Successful validation could transform minimally invasive gastrointestinal therapy and therapeutic endoscopy.
