The European Society of Gastrointestinal Endoscopy (ESGE) has issued a guideline on endoscopic submucosal dissection (ESD) for the treatment of gastrointestinal superficial lesions. The guideline is based on the GRADE system for assessing the strength of recommendations and the quality of evidence. It provides recommendations for the use of ESD and endoscopic mucosal resection (EMR) in various gastrointestinal locations, including the esophagus, stomach, duodenum, and colorectum. For superficial esophageal squamous cell cancers (SCCs), ESGE recommends en bloc resection, with ESD as the preferred option for en bloc resection and accurate pathology staging. EMR may be considered for smaller lesions if en bloc resection is assured. For Barrett's esophagus, ESGE recommends endoscopic resection with curative intent for visible lesions, with EMR preferred over ESD for mucosal cancer excision. ESD may be considered for larger lesions or those at risk for submucosal invasion. For gastric superficial neoplastic lesions with a very low risk of lymph node metastasis, ESGE recommends ESD as the treatment of choice. EMR is acceptable for smaller lesions with a very low probability of advanced histology. For colorectal lesions, ESD is recommended for those with high suspicion of limited submucosal invasion or for lesions that cannot be optimally removed by snare-based techniques. The guideline emphasizes the importance of accurate pre-procedure assessment, including high-resolution endoscopy, chromoendoscopy, and endoscopic ultrasound (EUS) for staging and risk assessment. It also highlights the need for proper post-procedure management, including endoscopic surveillance and follow-up. The guideline also addresses the safety of ESD, noting that while it is technically demanding, it has a lower risk of adverse events compared to surgery. It recommends ESD for lesions that are larger than 15 mm, poorly lifting tumors, and lesions at risk for submucosal invasion. The guideline also discusses the importance of en bloc resection for accurate histological staging and the role of ESD in reducing the risk of lymph node metastasis. The guideline concludes that ESD is a safe and effective treatment option for early gastrointestinal cancers, with a better safety profile compared to surgery. It recommends ESD as the first-line treatment for early gastric cancer, particularly in cases where en bloc resection is feasible. The guideline also emphasizes the importance of proper training and technical expertise for the successful implementation of ESD.The European Society of Gastrointestinal Endoscopy (ESGE) has issued a guideline on endoscopic submucosal dissection (ESD) for the treatment of gastrointestinal superficial lesions. The guideline is based on the GRADE system for assessing the strength of recommendations and the quality of evidence. It provides recommendations for the use of ESD and endoscopic mucosal resection (EMR) in various gastrointestinal locations, including the esophagus, stomach, duodenum, and colorectum. For superficial esophageal squamous cell cancers (SCCs), ESGE recommends en bloc resection, with ESD as the preferred option for en bloc resection and accurate pathology staging. EMR may be considered for smaller lesions if en bloc resection is assured. For Barrett's esophagus, ESGE recommends endoscopic resection with curative intent for visible lesions, with EMR preferred over ESD for mucosal cancer excision. ESD may be considered for larger lesions or those at risk for submucosal invasion. For gastric superficial neoplastic lesions with a very low risk of lymph node metastasis, ESGE recommends ESD as the treatment of choice. EMR is acceptable for smaller lesions with a very low probability of advanced histology. For colorectal lesions, ESD is recommended for those with high suspicion of limited submucosal invasion or for lesions that cannot be optimally removed by snare-based techniques. The guideline emphasizes the importance of accurate pre-procedure assessment, including high-resolution endoscopy, chromoendoscopy, and endoscopic ultrasound (EUS) for staging and risk assessment. It also highlights the need for proper post-procedure management, including endoscopic surveillance and follow-up. The guideline also addresses the safety of ESD, noting that while it is technically demanding, it has a lower risk of adverse events compared to surgery. It recommends ESD for lesions that are larger than 15 mm, poorly lifting tumors, and lesions at risk for submucosal invasion. The guideline also discusses the importance of en bloc resection for accurate histological staging and the role of ESD in reducing the risk of lymph node metastasis. The guideline concludes that ESD is a safe and effective treatment option for early gastrointestinal cancers, with a better safety profile compared to surgery. It recommends ESD as the first-line treatment for early gastric cancer, particularly in cases where en bloc resection is feasible. The guideline also emphasizes the importance of proper training and technical expertise for the successful implementation of ESD.