Endoscopic submucosal dissection (ESD) is a well- established technique of endoscopic resection that allows for en bloc removal of GI epithelial lesions. ESD differs
Copyright a 2015 by the American Society for Gastrointestinal Endoscopy. 0016-5107/$36.00
http://dx.doi.org/10.1016/j.gie.2014.12.010
from EMR, the other type of endoscopic resection. Both techniques involve injection of a substance under the tar- geted 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 un- der 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.1 Over the ensuing de- cades, procedural techniques and equipment for ESD have evolved significantly, and applications for ESD tech- niques 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 develop- ment of procedures with a therapeutic intent other than the resection of neoplasia, including peroral endoscopic myotomy for the treatment of achalasia.