Getting started in endoscopic submucosal dissection in the United States

Endoscopic resection has advanced substantially over the past six decades, with the advent of endoscopic polypectomy, endoscopic mucosal resection (EMR), and subsequently advanced endoscopic resection techniques such as endoscopic submucosal dissection (ESD) and endoscopic full thickness resection (EFTR). As endoscopic resection techniques become increasingly adopted, they have become favored as first-line therapy over surgical resection in the management of superficial neoplasms throughout the upper and lower gastrointestinal tract. ESD has become increasingly incorporated into standard endoscopic practice in the United States. However, the adoption of ESD has been highly variable and many practitioners in the United States have faced significant challenges both in ESD training as well as starting an independent practice focused on ESD and endoscopic resection. In this narrative review, we discuss the current landscape of ESD training in the United States, with a particular focus on how to start a practice in endoscopic resection.