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Endoscopic submucosal dissection (ESD) is a minimally invasive surgical technique primarily used to remove neoplastic lesions from the gastrointestinal tract, particularly in the stomach, esophagus, and colon. This procedure allows for the en-bloc resection of tumors that may be difficult to access or excise through traditional methods. ESD is characterized by its ability to achieve a complete, oncologically safe excision while preserving surrounding healthy tissue, which is vital in maintaining the function of the organ involved. The technique involves the careful injection of a fluid, typically a saline solution mixed with a dye or epinephrine, into the submucosal layer beneath the lesion. This step is crucial as it lifts the lesion away from the underlying muscularis layer, creating a safety margin for the dissection. Following the injection, specialized endoscopic instruments, including a knife or a diathermy device, are utilized to meticulously dissect the submucosal plane around the lesion, allowing for a complete removal. This precision in dissection not only aids in minimizing complications such as perforation or bleeding but also enhances the chance of complete tumor removal, decreasing the likelihood of recurrence. ESD requires a high level of skill and expertise from endoscopists, as it is a technically demanding procedure that necessitates the ability to gauge depth, manage bleeding, and navigate complexities presented by differing lesion types and locations. The procedure is generally performed under sedation or general anesthesia, and patients may experience a shorter recovery time when compared to traditional open surgical approaches, ultimately contributing to better patient outcomes. Moreover, ESD has been associated with lower rates of residual disease when compared to conventional therapies, such as endoscopic mucosal resection (EMR), particularly for larger tumors where complete excision is essential for effective treatment. Despite its advantages, ESD is not without risks. Potential complications include bleeding, perforation of the gastrointestinal wall, and infection, which necessitates a careful selection of patients who are likely to benefit most from ESD. Advances in technology, including the use of advanced endoscopic imaging techniques and the development of new therapeutic instruments, continue to enhance the efficacy and safety of ESD, making it an integral part of the therapeutic armamentarium for gastrointestinal malignancies. In summary, endoscopic submucosal dissection stands as a pivotal innovation in gastrointestinal surgery, combining the benefits of minimal invasiveness with the potential for complete surgical resection, thus reshaping the management strategies for early-stage cancers and precancerous lesions in the digestive tract.