Learning endoscopic submucosal dissection in the UK: Barriers, solutions and pathways for training

### Summary box #### What is already known on this topic #### What this paper adds #### What might be the impact on clinical practise in the foreseeable future Endoscopic submucosal dissection (ESD) has increasingly been adopted as the optimal approach for gastrointestinal (GI) high-grade intramucosal neoplasia and superficially invasive cancer. En bloc resection allows the pathological assessment of completeness of excision and multiple histological markers to more accurately indicate the statistical chance of lymph node metastasis. For benign lesions, there is also the benefit of a lower risk of recurrence.1 Despite the advantages of ESD, piecemeal endoscopic mucosal resection (pEMR) is still considered by some the technique of choice in the West with potential advantages rarely outweighing the drawbacks.2 For many others, however, the main barrier preventing the adoption of ESD is difficulty in learning the new technique and incorporating it into local and regional practice. This article explores the changing attitudes to ESD in the UK, the barriers faced by UK endoscopists wishing to adopt ESD, the potential solutions and a proposed structured approach to achieving safe independent practice. Many UK endoscopists who were initially sceptical about the value …