Submucosal Pressure Ejection Endoscopic Dissection (SPEED): A New Technique in Increasing the Safety and Efficacy of ESD (With Video).

OBJECTIVES: The universal adoption of endoscopic submucosal dissection (ESD) is limited by its technical demands, slow learning curve, long procedure time, and high risks of bleeding, muscular layer injury, and perforation. We developed the submucosal pressure ejection endoscopic dissection (SPEED) technique that combines pressure injection, incision, dissection, and coagulation and avoids frequent device exchange during ESD. We aimed to introduce this novel SPEED strategy and evaluate its therapeutic advantages for superficial gastrointestinal neoplasms. METHODS: Altogether 985 patients who underwent ESD for early gastrointestinal tumors between January 2020 and April 2024 were included and divided into the SPEED group and the conventional ESD group. Clinical outcomes, including en bloc and R0 resection rates, resection time, intraprocedural application of hemostatic forceps, procedure-related adverse events, and local recurrence, were evaluated. RESULTS: SPEED achieved en bloc and R0 resection rates of 99.85% and 99.40%, respectively. Compared with conventional ESD, SPEED was associated with a shorter median resection time (33 min vs. 57 min), less frequent intraprocedural application of hemostatic forceps (2.71% vs. 19.25%), a lower intraprocedural perforation rate (0.15% vs. 2.48%), and a lower post-procedure hemorrhage rate (1.51% vs. 5.90%). CONCLUSIONS: With the additional high-pressure injection, the SPEED technique greatly improves ESD efficiency and ensures a clearer visual field during ESD, thereby reducing risk of complications. It efficiently improves the speed and safety of dissection during ESD.