Endoscopic Submucosal Dissection

  • Anil Bernard Nagar
Part of the Clinical Gastroenterology book series (CG)


Endoscopic submucosal dissection (ESD) is an advanced endoscopic technique pioneered by the Japanese, for en bloc removal of large gastrointestinal epithelial lesions. This technique involves injection of a solution into the submucosal layer, followed by dissection around and then under the lesion, with separation of the submucosal layer using an electrocautery knife. ESD technique allows the endoscopist to visualize and control the depth of dissection. Originally described for early gastric cancer, the indications and techniques have evolved to include lesions in most locations and layers of the gastrointestinal wall. Western endoscopists have recently adopted this technique as well. From a practice standpoint, ESD provides the endoscopist with the ability to remove large superficial tumors in a single piece, including ulcerated lesions, lesions with submucosal fibrosis, recurrent neoplasms, non-lifting lesions, and potentially lesions with very early submucosal invasion. En bloc resection and curative resection rates are high in the eastern literature, with bleeding, perforation and strictures, the most frequently reported complications. The procedure is difficult and time consuming, with a steep learning curve and significant complication rates, and therefore requires specialized training.


Submucosal Dissection ESD En bloc resection 



Endoscopic mucosal resection


Endoscopic submucosal dissection


High-grade dysplasia


Intramucosal cancer

IT knife

Insulated-tip knife


Laterally spreading tumor


Narrowband imaging


Squamous cell carcinoma








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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Medicine, Section of Digestive DiseasesYale UniversityNew HavenUSA
  2. 2.VACT HealthcareWest Haven VA Medical CenterWest HavenUSA

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