421 The Current State of Endoscopic Submucosal Dissection (ESD) in the UK: A Nationwide Survey

Abstract Aim This study aimed to describe the current state of endoscopic submucosal dissection (ESD) in the UK, including training, practice trends, barriers to adoption, and views on robotics. Method An anonymous online survey was conducted between May and June 2025, targeting UK based endoscopists. Participants were recruited via professional societies and targeted emails. Results Twenty-eight eligible responses were analysed. Most respondents were gastroenterologists (79%) and predominantly male (82%). Responses were received from nearly all regions, with the largest proportions from Greater London (39%) and the South East (18%). Overall, 68% indicated they had completed an advanced fellowship (most commonly in the UK or Japan), and 82% had attended accredited ESD courses, with over half attending more than five. UGI ESD activity was predominantly low to medium volume (68%), while LGI ESD was more often performed at medium to high annual caseloads (61%). The majority routinely used tunnelling (93%) and traction-assisted techniques (82.1%). Most respondents used Narrow Band Imaging (93%) and white light endoscopy (86%) for lesion delineation, preferred colloidbased injection solutions (75%), and routinely added epinephrine (82%) and blue dye (100%). General anaesthesia was preferred for UGI ESD, conscious sedation for LGI ESD. Barriers to wider adoption included heavy workload (37%), low caseload (26%), and limited institutional support (19%). Nearly all respondents (93%) believed robotics have a future role, and 89% expressed interest in adopting robotic platforms. Conclusions These findings show established ESD expertise and training but highlight variable volumes and persistent barriers. Strong interest in robotics may help drive future adoption.