ESD

Endoscopic submucosal dissection (ESD) is a well established technique of endoscopic resection that allows for en bloc removal of GI epithelial lesions.

ESD differs from EMR, the other type of endoscopic resection. Both techniques involve injection of a substance under the targeted lesion to act as a cushion. With EMR, the lesion is then removed with a snare or suctioned into a cap and snared. With ESD, the submucosa is instead dissected under the lesion with a specialized knife. This enables removal of larger and potentially deeper lesions with a curative intent than can be accomplished with EMR. ESD was first described in 1988 as a technique to treat early gastric neoplasia nonoperatively.

Over the ensuing decades, procedural techniques and equipment for ESD have evolved significantly, and applications for ESD techniques have expanded to locations throughout the GI tract as well as to the treatment of deeper, nonepithelial lesions. The principles of ESD have also led to the development of procedures with a therapeutic intent other than the resection of neoplasia, including peroral endoscopic myotomy for the treatment of achalasia.