Proper Management and Prevention of Bleeding and Perforation in Endoscopic Submucosal Dissection

Abstract

Endoscopic submucosal dissection (ESD) has become widely accepted as a minimally invasive technique for the management of superficial neoplasia throughout the gastrointestinal tract. Despite its therapeutic benefits, ESD is technically demanding, with a steep learning curve and can be associated with serious adverse events (AEs). The most common and clinically significant AEs include intraprocedural or delayed bleeding and perforation. With prompt recognition and intervention, most of these AEs can be safely and adequately managed endoscopically. This review focuses on best practices for the prevention, early identification, and management of ESD-related bleeding and perforation. We aimed to provide insight into the tools, techniques, and general approach on how to mitigate and manage AEs that may arise with the goal of optimizing patient safety and the ongoing adoption of this therapeutic modality.