Endoscopic submucosal dissection: Challenges, innovations, and the road ahead.

Area of Science:

• Gastroenterology and Endoscopy
• Surgical Oncology
• Medical Technology Innovation

Background:

• Endoscopic submucosal dissection (ESD) provides a curative, organ-preserving option for early gastrointestinal cancers.
• Global adoption of ESD is inconsistent due to various challenges.
• These challenges include a steep learning curve, limited training access, long procedure times, and complication risks.

Purpose of the Study:

• To review the multifaceted challenges hindering the wider adoption of ESD.
• To explore innovations and emerging technologies that can improve ESD outcomes and accessibility.
• To provide a forward-looking perspective on the evolution of ESD as a therapeutic modality.

Main Methods:

• Literature review of challenges and innovations in ESD.
• Analysis of recent technological advancements (e.g., enhanced tools, AI, robotics).
• Examination of training and system-level support factors.

Main Results:

• Key barriers to ESD adoption identified: technical skill, training variability, procedural demands, and complications.
• Innovations like advanced tools, traction techniques, and digital platforms show promise in improving outcomes.
• Emerging technologies (AI, robotics, image guidance) are poised to enhance decision-making and procedural execution.

Conclusions:

• Addressing ESD limitations requires technical improvements and investment in training infrastructure.
• Technological advancements and system-level support are crucial for standardizing ESD.
• ESD has the potential to become a more accessible and widely adopted therapeutic option.