In the expanding arena of endoscopic management for Barrett’s neoplasia, how should we fit in endoscopic submucosal dissection?

Endoscopic submucosal dissection (ESD) is increasingly being performed for different indications in the GI tract. The main advantage of ESD is that it allows for en bloc resection of lesions larger than 15 mm, for which conventional snare-based endoscopic resection (ER) techniques would require piecemeal resection.1 En bloc resection of neoplastic lesions with ESD allows for optimal histopathologic evaluation, especially regarding the radicality at the deep and lateral resection margins. Another advantage of en bloc resection is that there is no risk of residual neoplastic remnants between adjacent resections, as might occur during piecemeal resection.

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