SAIMSARA Journal

Machine-Readable Science • ISSN 3054-3991

Endoscopic Submucosal Dissection for Gastric Neoplasia: Scoping Review with ☸️SAIMSARA

Gastrointestinal & Metabolic Health

Gastrointestinal & Metabolic Health

Issue 9, Volume 1, 2026

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DOI: 10.62487/saimsaraf14ad3f4

Editorial note
• Last update: 2026-05-30 23:39:49
What is this paper about
Gastric ESD is not simply a technical alternative to surgery — this review shows where it truly works, where it becomes risky, and which anatomical settings demand expert-level planning. The full read maps 330 references across early gastric cancer, remnant stomach, gastric tube lesions, bleeding risk, perforation, traction methods, novel injection materials, training pathways, and surveillance to clarify one practical message: ESD success depends less on feasibility than on correct lesion selection, procedural difficulty control, and long-term metachronous cancer surveillance.
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Abstract: To synthesize original research on gastric endoscopic submucosal dissection (ESD), emphasizing clinical effectiveness, safety, technical difficulty, comparative treatment positioning, risk stratification, procedural innovation, training, postoperative management, surveillance, and applicability across special gastric settings such as the remnant stomach, gastric tube, proximal stomach, elderly patients, and subepithelial or rare gastric tumors. The review uses 330 references and builds its evidence map from 918 original studies with 327325 total participants/sample observations (topic-deduplicated ΣN). Across the mapped evidence, gastric ESD emerges as a consistently effective organ-preserving treatment for selected early gastric neoplasia, with en bloc resection rates of 91–97% and curative resection around 65–79% in representative cohorts, and with complication and survival profiles comparable or superior to gastrectomy in matched populations. The dominant signal is that outcomes are shaped less by feasibility than by anatomic and pathological complexity, with upper-third location, larger size, fibrosis, remnant or gastric-tube anatomy, and antithrombotic exposure repeatedly identified as drivers of difficulty, non-curative resection, and bleeding or perforation risk. Procedural innovations including traction methods, novel injection materials, and structured training pathways were associated with improved efficiency and safety, supporting their integration into difficult-location practice. Surveillance after curative ESD remains essential given persistent metachronous risk even after H. pylori eradication. Future work should prioritize prospective, multicenter validation of integrated risk models and competency benchmarks tailored to high-difficulty gastric settings.

Keywords: Endoscopic submucosal dissection; Early gastric cancer; Stomach neoplasms; Remnant stomach; Gastric ESD; En bloc resection; Curative resection; Delayed perforation; Post-ESD ulcer; Submucosal invasion

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Reference Index (330)

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