The European Society of Gastrointestinal Endoscopy (ESGE) has issued guidelines for the use of endoscopic submucosal dissection (ESD) in the treatment of gastrointestinal superficial lesions. The guidelines are based on evidence and consensus and provide recommendations for the clinical indications, technical details, and post-ESD management. Key recommendations include: 1. **Esophageal Squamous Cell Carcinomas (SCCs)**: ESGE recommends endoscopic en bloc resection for superficial SCCs, excluding those with obvious submucosal involvement. Endoscopic mucosal resection (EMR) can be considered for smaller lesions if an en bloc resection can be assured. However, ESD is recommended as the first option to ensure accurate pathology staging and avoid missing important histological features. 2. **Barrett's Esophagus**: ESGE recommends endoscopic resection with a curative intent for visible lesions in Barrett's esophagus. EMR is preferred over ESD, but ESD may be considered for selected cases, such as larger lesions, poorly lifting tumors, and lesions at risk for submucosal invasion. 3. **Gastric Superficial Neoplastic Lesions**: ESGE recommends endoscopic resection for gastric superficial neoplastic lesions with a very low risk of lymph node metastasis. EMR is an acceptable option for smaller lesions, while ESD is recommended as the treatment of choice for most gastric superficial neoplastic lesions. 4. **Colonic and Rectal Superficial Lesions**: ESGE states that most colonic and rectal superficial lesions can be effectively removed by standard polypectomy and/or EMR. ESD can be considered for lesions with high suspicion of limited submucosal invasion or when snare-based techniques cannot provide optimal and radical removal. The guidelines also provide detailed recommendations on pre-endoscopic resection evaluation, management based on technical and histological outcomes, and post-therapy surveillance. The aim is to provide caregivers with comprehensive guidance to ensure safe and effective endoscopic resection of gastrointestinal superficial lesions.The European Society of Gastrointestinal Endoscopy (ESGE) has issued guidelines for the use of endoscopic submucosal dissection (ESD) in the treatment of gastrointestinal superficial lesions. The guidelines are based on evidence and consensus and provide recommendations for the clinical indications, technical details, and post-ESD management. Key recommendations include: 1. **Esophageal Squamous Cell Carcinomas (SCCs)**: ESGE recommends endoscopic en bloc resection for superficial SCCs, excluding those with obvious submucosal involvement. Endoscopic mucosal resection (EMR) can be considered for smaller lesions if an en bloc resection can be assured. However, ESD is recommended as the first option to ensure accurate pathology staging and avoid missing important histological features. 2. **Barrett's Esophagus**: ESGE recommends endoscopic resection with a curative intent for visible lesions in Barrett's esophagus. EMR is preferred over ESD, but ESD may be considered for selected cases, such as larger lesions, poorly lifting tumors, and lesions at risk for submucosal invasion. 3. **Gastric Superficial Neoplastic Lesions**: ESGE recommends endoscopic resection for gastric superficial neoplastic lesions with a very low risk of lymph node metastasis. EMR is an acceptable option for smaller lesions, while ESD is recommended as the treatment of choice for most gastric superficial neoplastic lesions. 4. **Colonic and Rectal Superficial Lesions**: ESGE states that most colonic and rectal superficial lesions can be effectively removed by standard polypectomy and/or EMR. ESD can be considered for lesions with high suspicion of limited submucosal invasion or when snare-based techniques cannot provide optimal and radical removal. The guidelines also provide detailed recommendations on pre-endoscopic resection evaluation, management based on technical and histological outcomes, and post-therapy surveillance. The aim is to provide caregivers with comprehensive guidance to ensure safe and effective endoscopic resection of gastrointestinal superficial lesions.