Bu F, Zhang SY, Liu ZJ. Anesthesiologist’s perspective on endoscopic submucosal dissection: Bridging minimally invasive surgery and enhanced recovery after surgery management. World J Gastrointest Surg 2026; 18(1): 114299 [DOI: 10.4240/wjgs.v18.i1.114299]
Corresponding Author of This Article
Zi-Jia Liu, MD, Assistant Professor, Associate Chief Physician, Department of Anesthesiology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Beijing 100730, China. liu-zj02@126.com
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Anesthesiology
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Letter to the Editor
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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 27, 2026 (publication date) through Jan 28, 2026
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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Bu F, Zhang SY, Liu ZJ. Anesthesiologist’s perspective on endoscopic submucosal dissection: Bridging minimally invasive surgery and enhanced recovery after surgery management. World J Gastrointest Surg 2026; 18(1): 114299 [DOI: 10.4240/wjgs.v18.i1.114299]
World J Gastrointest Surg. Jan 27, 2026; 18(1): 114299 Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.114299
Anesthesiologist’s perspective on endoscopic submucosal dissection: Bridging minimally invasive surgery and enhanced recovery after surgery management
Fan Bu, Sheng-Yu Zhang, Zi-Jia Liu
Fan Bu, Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China
Sheng-Yu Zhang, Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
Zi-Jia Liu, Department of Anesthesiology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
Author contributions: Bu F drafted the first version; Zhang SY proposed the initial concept and conducted the literature review; Bu F and Liu ZJ collaborated to revise the draft and finalize the manuscript; and all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Zi-Jia Liu, MD, Assistant Professor, Associate Chief Physician, Department of Anesthesiology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Beijing 100730, China. liu-zj02@126.com
Received: September 16, 2025 Revised: October 24, 2025 Accepted: December 4, 2025 Published online: January 27, 2026 Processing time: 127 Days and 21.5 Hours
Abstract
In this article, we comment on the recent article by Fang et al. The study highlights that endoscopic submucosal dissection (ESD) offers advantages such as minimal incisions, shorter operative time, reduced bleeding, and faster patient recovery, demonstrating its strong alignment with the principles of enhanced recovery after surgery (ERAS). From an anesthesiologic perspective, ESD contributes to decreased intraoperative stress, thereby reducing opioid requirements. Simultaneously, the shorter procedure duration and minimal tissue trauma mitigate the adverse effects of deep anesthesia on circulatory and respiratory functions, leading to a more stable emergence from anesthesia and smoother endotracheal extubation. Ultimately, the minimally invasive nature of ESD is crucial for minimizing postoperative nausea and vomiting and preventing postoperative delirium. Historically, ERAS protocols have primarily focused on open and laparoscopic surgeries, with a lack of systematic ERAS guidelines for endoscopic treatments. Therefore, anesthesiology departments should take a more proactive role in the perioperative care of patients undergoing endoscopic procedures, spearheading the development of a standardized “ESD-ERAS” pathway.
Core Tip: Compared to laparoscopic gastrectomy, endoscopic submucosal dissection (ESD) offers advantages in treating early gastric cancer, including fewer postoperative complications and shorter hospital stays. From an anesthesiologist’s perspective, ESD procedures reduce postoperative nausea and vomiting, facilitate perioperative anesthesia management, and decrease postoperative delirium in patients. This aligns with the principles of enhanced recovery after surgery. However, no standardized ERAS protocol currently exists for ESD. Therefore, we propose several efforts anesthesiologists can undertake within the enhanced recovery after surgery framework.
