Moutzoukis MK, Manolakis A, Kapsoritakis A, Christodoulou D, Argyriou K. Endoscopic submucosal dissection: Challenges, innovations, and the road ahead. World J Gastrointest Endosc 2026; 18(1): 113918 [DOI: 10.4253/wjge.v18.i1.113918]
Corresponding Author of This Article
Konstantinos Argyriou, Department of Gastroenterology, University Hospital of Larisa, Mezourlo, Larisa 41100, Greece. kosnar2@yahoo.gr
Research Domain of This Article
Gastroenterology & Hepatology
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Review
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 16, 2026 (publication date) through Jan 15, 2026
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Publication Name
World Journal of Gastrointestinal Endoscopy
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1948-5190
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Moutzoukis MK, Manolakis A, Kapsoritakis A, Christodoulou D, Argyriou K. Endoscopic submucosal dissection: Challenges, innovations, and the road ahead. World J Gastrointest Endosc 2026; 18(1): 113918 [DOI: 10.4253/wjge.v18.i1.113918]
World J Gastrointest Endosc. Jan 16, 2026; 18(1): 113918 Published online Jan 16, 2026. doi: 10.4253/wjge.v18.i1.113918
Endoscopic submucosal dissection: Challenges, innovations, and the road ahead
Miltiadis K Moutzoukis, Anastasios Manolakis, Andreas Kapsoritakis, Dimitrios Christodoulou, Konstantinos Argyriou
Miltiadis K Moutzoukis, Department of Gastroenterology, University Hospital of Ioannina, Ioannina GR45333, Greece
Anastasios Manolakis, Andreas Kapsoritakis, Konstantinos Argyriou, Department of Gastroenterology, University Hospital of Larisa, Larisa 41100, Greece
Dimitrios Christodoulou, Department of Gastroenterology, Medical School and University Hospital of Ioannina, Ioannina GR45500, Greece
Author contributions: Moutzoukis MK wrote and edited the manuscript; Argyriou K and Christodoulou D conceived the study and edited and finalized the manuscript for submission; Argyriou K, Manolakis A, Kapsoritakis A, and Christodoulou D reviewed and approved the submitted manuscript; All authors read and approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Konstantinos Argyriou, Department of Gastroenterology, University Hospital of Larisa, Mezourlo, Larisa 41100, Greece. kosnar2@yahoo.gr
Received: September 7, 2025 Revised: October 9, 2025 Accepted: November 21, 2025 Published online: January 16, 2026 Processing time: 130 Days and 17.9 Hours
Abstract
Endoscopic submucosal dissection (ESD) offers a curative, organ-preserving approach for early-stage gastrointestinal tumors, yet its global adoption remains inconsistent. This review examined the multifaceted challenges hindering wider use of ESD, including the steep technical learning curve, variability in training access, procedural time demands, and risk of complications. We explored recent innovations aimed at improving procedural outcomes and reducing operator dependency, such as enhanced dissection tools, traction techniques, and digital training platforms. In addition, emerging technologies, such as artificial intelligence, robotics, and image-guided systems, are reshaping the procedural landscape and may help streamline both decision-making and execution. Looking forward, addressing the current limitations of ESD will require technical refinement as well as broader investment in training infrastructure and system-level support. This article outlined key areas for development and provided a forward-looking perspective on how ESD may evolve into a more accessible and standardized therapeutic modality.
Core Tip: Endoscopic submucosal dissection enables curative, organ-preserving treatment of early gastrointestinal neoplasia, but its adoption is limited by technical complexity, long procedure times, and uneven training opportunities. Recent advances including novel dissection tools, traction methods, and digital training along with emerging technologies such as artificial intelligence and robotics, have the potential to overcome these barriers. Future progress will depend on both technological innovation and system-level strategies to expand training and standardize practice worldwide.
