Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review.

ESGE suggests conventional endoscopic submucosal dissection (ESD; marking and mucosal incision followed by circumferential incision and stepwise submucosal dissection) for most esophageal and gastric lesions. ESGE suggests tunneling ESD for esophageal lesions involving more than two-thirds of the esophageal circumference. ESGE recommends the pocket-creation method for colorectal ESD, at least if traction devices are not used. The use of dedicated ESD knives with size adequate to the location/thickness of the gastrointestinal wall is recommended. It is suggested that isotonic saline or viscous solutions can be used for submucosal injection. ESGE recommends traction methods in esophageal and colorectal ESD and in selected gastric lesions. After gastric ESD, coagulation of visible vessels is recommended, and post-procedural high dose proton pump inhibitor (PPI) (or vonoprazan). ESGE recommends against routine closure of the ESD defect, except in duodenal ESD. ESGE recommends corticosteroids after resection of  > 50 % of the esophageal circumference. The use of carbon dioxide when performing ESD is recommended. ESGE recommends against the performance of second-look endoscopy after ESD. ESGE recommends endoscopy/colonoscopy in the case of significant bleeding (hemodynamic instability, drop in hemoglobin > 2 g/dL, severe ongoing bleeding) to perform endoscopic hemostasis with thermal methods or clipping; hemostatic powders represent rescue therapies. ESGE recommends closure of immediate perforations with clips (through-the-scope or cap-mounted, depending on the size and shape of the perforation), as soon as possible but ideally after securing a good plane for further dissection.

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European Society of Gastrointestinal Endoscopy. All rights reserved.

Déclaration de conflit d'intérêts

P. Bhandari has received speaker's fees and research grants from Olympus, Fujifilm, and Boston Scientific (2019 to 2022). R. Bisschops has received grants/research support, and speaker’s fee/honoraria from Pentax, Fujifilm, and Medtronic (from 2019, ongoing); his department has received research grants from Pentax, Fujifilm, and Medtronic (from 2019, ongoing). M.J. Bourke has received research support from Boston Scientific (2016 to 2023, ongoing); his department has received research support from Olympus (2016 to 2023, ongoing); he has provided research support to Cook Medical (2016 to 2023, ongoing). P.H. Deprez has received teaching fees from and provided consultancy to Olympus (2021 to 2023), and received teaching fees from Erbe (2021 to 2023). M. Dinis-Ribeiro has provided consultancy to Medtronic and Roche (2021 to 2022); his department has received research support (loan) form Fufifilm (2021 to 2022); he is the Co-Editor-in-Chief of Endoscopy journal. P. Leclercq has provided paid consultancy to Medtronic (2021). A. Lemmers receives lecture fees from Creo Medical (January 2022 to June 2023); his department has received a research grant from Boston Scientific (December 2021 to February 2023). R. Maselli has provided consultancy to Erbe, Fujifilm, and Apollo Endosurgery (2018 to present). H. Messmann’s department has received support from Olympus and Satisfai; he has provided consultancy to Ambu, Boston Scientific, and Olympus. O. Pech has received speaker’s honoraria from Medtronic and Boston Scientific (2018 to 2022). M. Pioche has been involved in ESD training sessions with Olympus, Pentax, and Cook (from 2018 to (2023); his institution has applied for a patent for the A-TRACT traction device. B.L.A.M. Weusten has provided consultancy to, and received lecture fees and research funding from Pentax Medical (2020 to 2023); his department has received research funding from Aqua Medical (2020 to 2022); he has been involved in research projects with funding from C2 Therapeutics (2016 to 2020). B. Bastiaansen, G. Esposito, L. Fuccio, D. Libânio, Pedro Pimentel-Nunes, and Michael Vieth have no competing interests.