Progress, pitfalls, and the path forward of endoscopic submucosal dissection in the United States.

Endoscopic submucosal dissection (ESD) has continued to gain traction in the United States over the past decades, with a growing number of publications highlighting its safety and efficacy when performed at specialized centers. However, technical pre-requisites to training, regional variation in disease patterns, lack of availability and standardization in ESD training, as well as lack of dedicated billing codes and reimbursement are some of the current pitfalls in its dissemination beyond expert centers. Herein we outline the progress of ESD in the United States over recent years, outlining clinical outcomes, addressing barriers to its adaptation, and discussing future directions in the field.