Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Jun 23;5(1):e394.
doi: 10.1002/deo2.394. eCollection 2025 Apr.

Colorectal endoscopic submucosal dissection in the USA: The current state and future perspectives

Abdulrahman Qatomah  1   2 , Hiroyuki Aihara  3
Affiliations
Review

Colorectal endoscopic submucosal dissection in the USA: The current state and future perspectives

Abdulrahman Qatomah et al. DEN Open. .

Abstract

Endoscopic submucosal dissection (ESD) is a transformative advancement in the endoscopic management of superficial gastrointestinal lesions. Initially conceived for the treatment of early gastric cancer, ESD has demonstrated proficiency in achieving en-bloc resection of superficial gastrointestinal lesions. ESD has experienced widespread acceptance in Japan and East Asia; however, its adoption in the USA remains delayed. This initial hesitancy could be attributed to procedural complexity and training demands; nonetheless, recently, ESD has been gaining popularity in the USA. This is due to the advancements in endoscopic technology, tailored training programs, and cumulative evidence regarding the efficacy and safety of ESDs. This review aimed to deliberate the historical progress, current implementation, and prospective trajectory of ESDs in the USA. With ongoing clinical research, technological integration, and educational efforts, ESD is likely to become the gold standard for managing large gastrointesitinal lesions. This progress marks an imperative step toward less invasive, more precise, and patient-centric approaches regarding advanced therapeutic endoscopy in the USA.

Keywords: education; endoscopic submucosal dissection; robotic endoscopy; traction; training.

PubMed Disclaimer

Conflict of interest statement

Abdulrahman Qatomah has nothing to declare. Hiroyuki Aihara is a consultant for Olympus America, Fujifilm Medical Systems, Boston Scientific, ConMed, MicroTech, BioDevek, and Endoquest Robotics. Hiroyuki Aihara receives a research fund from Boston Scientific.

Figures

FIGURE 1
FIGURE 1
Diagram summarizing the factors influencing the quality of endoscopic submucosal dissection (ESD) training.
FIGURE 2
FIGURE 2
Endoscopic submucosal dissection (ESD) knives available in the United States of America (USA). (a) IT2 knife (Olympus America). (b) IT2 knife nano (Olympus America). (c) DualKnife‐J (Olympus America). (d) HookKnife‐J (Olympus America). (e) Flush Knife (Fujifilm). (f) ORISE ProKnife (Boston Scientific). (g) HybridKnife (ERBE USA). (h) SB knife (Olympus America). (i) Clutch cutter (Fujifilm). (j) ProdGI (Medtronic America). (k) Speedboat (Creo Medical America).
FIGURE 3
FIGURE 3
(a) BlueBoost (Micro‐Tech Endoscopy). (b) 6% Hetastarch.
FIGURE 4
FIGURE 4
(a) Coagasper (Olympus America). (b) Ensure Grasper (Micro‐Tech Endoscopy).
FIGURE 5
FIGURE 5
SureTrac (Micro‐Tech Endoscopy).
FIGURE 6
FIGURE 6
Endoscopic suturing devices: (a) Overstitch device (Apollo Endosurgery/Boston Scientific). (b) X‐Tack device (Apollo Endosurgery/ Boston Scientific).
FIGURE 7
FIGURE 7
TracMotion (Fujifilm).
FIGURE 8
FIGURE 8
Dual action tissue (DAT) clip (Micro‐Tech Endoscopy).
FIGURE 9
FIGURE 9
Flex robotic system (Medrobotics).
FIGURE 10
FIGURE 10
Flexible endoscopic robotic system (EndoQuest Robotics): (a) Physician console. (b) Patient cart.
See this image and copyright information in PMC

References

    1. Hosokawa K, Yoshida S. Recent advances in endoscopic mucosal resection for early gastric cancer. Jpn J Cancer Chemother 1998; 25: 476–483. [in Japanese with English abstract]. - PubMed
    1. Ohkuwa M, Hosokawa K, Boku N, Ohtu A, Tajiri H, Yoshida S. New endoscopic treatment for intramucosal gastric tumors using an insulated‐tip diathermic knife. Endoscopy 2001; 33: 221–226. - PubMed
    1. Ono H, Kondo H, Gotoda T et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48: 225–229. - PMC - PubMed
    1. Kondo H, Gotoda T, Ono H et al. Percutaneous traction‐assisted EMR by using an insulation‐tipped electrosurgical knife for early‐stage gastric cancer. Gastrointest Endosc 2004; 59: 284–288. - PubMed
    1. Gotoda T. A large endoscopic resection by endoscopic submucosal dissection procedure for early gastric cancer. Clin Gastroenterol Hepatol 2005; 3: S71–S73. - PubMed