ESD – does techniques matter?(Endoscopy, Jan-2026)

Yes, techniques for Endoscopic Submucosal Dissection (ESD) matter significantly, as different techniques demonstrate varying advantages and outcomes depending on the clinical scenario. Based on the synthesized evidence from 18 randomized controlled trials (RCTs) involving 2,677 patients, three major techniques for ESD were compared:

1. **Tunnel/Pocket Method (Tu-ESD)**

2. **Traction Method (Tr-ESD)**

3. **Conventional Method (C-ESD)**

### Key Findings:

• **Tu-ESD** achieved the highest ranking for **curative resection** (score 92.1) and was best for minimizing adverse events.
• **Tr-ESD** ranked highest for **reducing procedure time** (score 100) and demonstrated significant reductions in procedure time compared with C-ESD (mean difference: –18.74 minutes).
• Subgroup analyses by colorectal, gastric, and esophageal locations showed that:
• **Tr-ESD** was superior for en bloc resection and procedure time.
• **Tu-ESD** was best for curative resection and minimizing adverse events.

### Conclusion:

Both Tu-ESD and Tr-ESD were found to be effective and safe compared to the conventional method (C-ESD). Given that different techniques offer distinct advantages, the choice of ESD technique should be tailored to the specific clinical scenario, lesion location, and procedural goals. This highlights the importance of selecting the appropriate method to optimize outcomes in ESD procedures.