HYPOTHESIS AND THEORY article
Front. Med.
Sec. Gastroenterology
Drug-Targeted Endoscopic Submucosal Dissection (DT-ESD): A Hypothetical Framework Toward Non-Electromechanical Mucosal Resection
Provisionally accepted
- Putian University, Putian, China
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Endoscopic submucosal dissection (ESD) is a widely used technique for en bloc resection of gastrointestinal neoplasms. However, it is technically demanding, time-consuming, and associated with risks such as perforation and bleeding, primarily due to the reliance on electromechanical dissection. In this theoretical proposal, we introduce a novel concept termed "Drug-Targeted Endoscopic Submucosal Dissection (DT-ESD)", which aims to partially replace mechanical dissection by localized chemical degradation of the submucosa. The proposed method preserves most procedural steps of conventional ESD but incorporates selective enzymatic digestion to facilitate submucosal separation. This approach has the potential to reduce procedure time, thermal injury, and technical complexity. We detail the conceptual workflow, candidate agents, delivery strategy, potential advantages, and risks. Though theoretical at this stage, DT-ESD represents a potential paradigm shift in endoscopic therapy. Further validation in Ex vivo and in vivo models is needed. If validated, DT-ESD could transform the paradigm of minimally invasive gastrointestinal therapy and could represent a transformative advancement in therapeutic endoscopy.
Keywords: endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), submucosal injection, Superficial gastrointestinal neoplasms, Therapeutic Endoscopy
Received: 17 Jul 2025; Accepted: 14 Nov 2025.
Copyright: © 2025 Li, Xu and Song. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Conghua Song, kesongs@email.ncu.edu.cn
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