As a Senior Associate Editor @GIE_Journal , I selected six standout studies this year that each offer a unique perspective on the evolution of ESD. 🔹 Deep endotracheal intubation for cervical esophageal ESD A simple modification in anesthesia," advancing the tube deeper," resulted in shorter procedure time and zero post-ESD stenosis in the most anatomically restricted part of the esophagus ( cervical esophagus). A highly practical improvement without a significant change in technique. 🔹 Underwater versus conventional ESD for colorectal lesions (randomized trial) The largest RCT to date found no difference in dissection speed, showing that underwater ESD is best used selectively rather than as a universal default. 🔹 Underwater ESD meta-analysis Pooling all published evidence tells a more favorable story, with faster dissection and shorter procedures overall. This contrasts with the above RCT, which highlights how lesion type and operator technique influence outcomes. 🔹 Tunneling and pocket-creation methods for gastric ESD Techniques initially designed for colon ESD are now proving their value in gastric ESD, offering faster dissection and fewer perforations than conventional methods. 🔹 Circumferential RFA after curative ESD for ESCC A landmark pilot RCT demonstrated a dramatic reduction in 5-year metachronous recurrence (0% vs 53%), signaling a potential shift in post-ESD management for squamous disease. 🔹 Double-balloon overtube platform for colorectal ESD A prospective randomized study showed significantly shorter procedure times and higher en bloc resection rates, reinforcing the role of platform stability in transforming Western ESD performance. Collectively, these six studies showcase the ongoing innovation making ESD safer, more efficient, and increasingly adaptable across the GI tract. Happy Thanksgiving! giejournal.org/article/S0016…