Endoscopic Submucosal Dissection (ESD) Techniques

Indications and Benefits

The European Society of Gastrointestinal Endoscopy (ESGE) recommends a stepwise approach for ESD in the colon, which reduces the risk of perforation and improves procedure control 1
In the stomach, conventional ESD (marking and incision of the mucosa, followed by circular incision and stepwise submucosal dissection) is recommended for most lesions, with a standard technique involving full circular incision to isolate the lesion with a 3-4 mm margin of normal mucosa 2
Hybrid ESD (partial submucosal dissection with subsequent en bloc resection using a loop) is a safer alternative to full ESD in the colon, especially when traction devices are not used 1

The choice of endoscopic knife size, adapted to the location and wall thickness of the gastrointestinal tract, is crucial for procedure safety 2
The use of traction methods in ESD for the esophagus and colon, as well as in selected gastric lesions, improves visibility and control during dissection 2

The stepwise approach reduces the risk of perforation, which is the most common complication of ESD (more frequent than in EMR) 1
The ability to better assess the depth of dissection and avoid damage to the muscular layer is a key advantage of the stepwise approach 2