Commentary

10.1055/a-2626-3707

Congratulations to the authors on an inventive and highly novel iteration of endoscopic submucosal dissection (ESD) that advances the conversation on safety. By minimizing electrocautery, cold-ESD plausibly reduces intraprocedural perforation and delayed bleeding – a meaningful gain, even if most such complications are rare. This approach may be particularly useful for clearly low grade dysplastic lesions, and it could also address the issue of high recurrence rates after piecemeal cold snare polypectomy of low profile adenomas. The central oncologic issue persists with submucosal invasion, where the precision and deep margin assessment of electrosurgical ESD clearly outperform “cold” techniques. This also applies to severely fibrotic lesions. Moreover, as the authors employ vessel coagulation, the “cold” designation is relative rather than absolute and deserves clarification. Clearly further study is required, however at least in Western practice, cold-ESD appears best suited as a selective adjunct rather than a broadly applicable strategy.

Publication History

Article published online:
27 November 2025