The current state of endoscopic submucosal dissection in the UK: a nationwide cross-sectional survey

Abstract Background Endoscopic submucosal dissection (ESD) enables en bloc resection of early gastrointestinal (GI) neoplasia, but its adoption in Western countries has been limited by training and service constraints. This study aimed to describe the current landscape of ESD in the UK. Methods A nationwide, cross-sectional, anonymised online survey was conducted among UK endoscopists independently performing either upper and/or lower GI ESD. Results Twenty-eight responses were analysed. Most respondents were gastroenterologists (79%) and male (82%). Responses were received from across the UK, with the largest proportions from Greater London (39%) and the South East (18%). Overall, 68% had completed an advanced fellowship (commonly in the UK or Japan), and 82% had attended accredited ESD courses, often on multiple occasions. Across all ESD sites, only a minority perform more than 20 procedures annually, with high-volume practice largely confined to rectal ESD. Narrow Band Imaging (93%) and white light endoscopy (86%) were the most commonly used delineation methods; colloid-based solutions (75%), epinephrine (82%), and blue dye (100%) were widely used for submucosal injection. Most respondents routinely used tunnelling (93%) and traction-assisted techniques (82%). General anaesthesia was preferred for upper GI ESD (82%), and conscious sedation for lower GI ESD (46%). Reported barriers to training included heavy workload (37%), low caseload (26%), and limited institutional support (19%). Nearly all respondents (93%) believed robotics has a future role in ESD. Conclusions Independent ESD practice in the UK is delivered by a small workforce, with heterogeneous training backgrounds and procedural volumes often below recommended thresholds. National strategies for structured training, centralisation, and coordinated service planning are needed to support safe and sustainable expansion of ESD. Graphical abstract