Endoscopic Submucosal Dissection for Early Gastric Cancer: Current Standard Indication and Management

Endoscopic submucosal dissection (ESD) has been established as the standard treatment for early gastric cancer, enabling en bloc resection regardless of lesion size and offering high curability with organ preservation. The indications for ESD have expanded with the accumulation of long-term data, and recent guidelines from Korea, Japan, and Western countries share similar criteria, although subtle differences regarding the undifferentiated-type histology remain. Despite its efficacy, ESD remains technically demanding, particularly for lesions with severe fibrosis or those located at difficult anatomical sites. Furthermore, as the population ages, perioperative management with antithrombotic agents has become a critical safety issue. This review provides a comprehensive overview of the current indications and clinical outcomes of ESD based on large-scale global data. It also offers practical strategies for overcoming technical difficulties and managing adverse events, with a specific focus on updated guidelines for antithrombotic agents and perforation management.