Endoscopic submucosal dissection for early gastrointestinal malignancies: Current state and future perspectives

Abstract

Endoscopic submucosal dissection (ESD) has emerged as a pivotal therapeutic modality for early gastrointestinal (GI) cancers, providing a minimally invasive approach with curative potential. This technique enables the en bloc resection of neoplastic lesions confined to the mucosa and submucosa, thereby preserving organ function and reducing the need for more radical surgical interventions. ESD provides diagnostic clarity and enhances patient survival rates when performed by skilled practitioners in the early stages of GI cancers such as esophageal, gastric, and colorectal carcinomas. This article examines the indications, procedural advancements, technical considerations, and outcomes associated with ESD in early GI cancers. The challenges and complications that can arise are also highlighted. Additionally, we discuss the evolving role of novel techniques and adjunctive therapies to improve safety and efficacy. As the field progresses, ESD remains a cornerstone in managing early GI cancers, offering patients a promising option for organ preservation and long-term survival.

Keywords: Chromoendoscopy; Narrow band imaging; Hyperplastic; Submucosal; Polypoid; En bloc resection; Early gastrointestinal cancer; Endoscopic mucosal resection; Endoscopic submucosal dissection

Core Tip: This article provides a comprehensive overview of endoscopic submucosal dissection for early esophageal, gastric, and colon cancers, detailing technical approaches, common pitfalls, and current evidence. This review also discusses the management of common procedural complications. Gastroenterologists can use this guide to improve outcomes and optimize the application of endoscopic submucosal dissection in managing early gastrointestinal cancer.