Post written by Shaimaa Elkholy, MD, Mohamed El Sherbiny, MD, and Karim Essam, MD, from the Gastroenterology Division, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

Endoscopic submucosal dissection (ESD) is a minimally invasive technique used for resection of GI lesions. Our recently published video article in VideoGIE presents a comparative and practical overview of ESD techniques. These include classic, pocket, modified pocket, bridge, multiple tunnel, traction-assisted, and hybrid ESD techniques.

The video includes cases that illustrate various procedural challenges—such as lesion size, location, submucosal fibrosis, and restricted scope maneuverability—and demonstrates how different techniques can be selectively used to address these specific challenges.

A key message of the video is that no single ESD technique is ideal for all scenarios. Each method has its own advantages and limitations, and recognizing these nuances is essential for achieving successful outcomes. Our video highlights indications, benefits, and limitations of each technique and shows how to overcome these limitations by incorporating alternative methods. Rather than promoting a single dominant approach, we advocate for flexible technique selection based on lesion characteristics, operator expertise, and procedural complexity.

The goal of this work is to encourage endoscopists—particularly those in training or early practice—to move beyond a one-size-fits-all mindset and adopt a more individualized strategy. As in ESD, there are no rigid rules, and a tailored approach is essential for managing each lesion effectively.

We believe this contribution enhances the expanding body of video-based educational content in advanced endoscopy. It reinforces the value of technical versatility in achieving safe and complete resections. We hope this video serves as a valuable educational resource for endoscopists seeking to refine their ESD technique and adopt a more tailored, evidence-based approach in daily practice.

A, Tailored ESD approach for esophageal and gastric lesions: For circumferential esophageal lesions, multiple tunnel method can be used. For noncircumferential lesions, the pocket or modified pocket, or even classic ESD with or without traction could be used. For gastric lesions, the pocket or modified pocket technique is recommended. If not feasible, the classic ESD method with or without traction could be used. B, Tailored ESD approach for colorectal lesions: For circumferential rectal lesions, multiple tunnel method could be used. For noncircumferential lesions, bridge ESD is preferred; if not feasible, we can use either pocket or modified pocket or even classic ESD with or without traction. For colonic lesion less than 3 cm, hybrid ESD can be used if en bloc resection can be assured. In larger lesions, we can use pocket, modified pocket, bridge, or even classic ESD with or without traction. ESD, Endoscopic submucosal dissection.

Read the full article online.

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