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The use of dedicated ESD knives with size adequate to the location\/thickness of the gastrointestinal wall is recommended. It is suggested that isotonic saline or viscous solutions can be used for submucosal injection. ESGE recommends traction methods in esophageal and colorectal ESD and in selected gastric lesions. After gastric ESD, coagulation of visible vessels is recommended, and post-procedural high dose proton pump inhibitor (PPI) (or vonoprazan). ESGE recommends against routine closure of the ESD defect, except in duodenal ESD. ESGE recommends corticosteroids after resection of \u200a&gt;\u200a50\u200a% of the esophageal circumference. The use of carbon dioxide when performing ESD is recommended. ESGE recommends against the performance of second-look endoscopy after ESD. ESGE recommends endoscopy\/colonoscopy in the case of significant bleeding (hemodynamic instability, drop in hemoglobin &gt;\u200a2\u200ag\/dL, severe ongoing bleeding) to perform endoscopic hemostasis with thermal methods or clipping; hemostatic powders represent rescue therapies. ESGE recommends closure of immediate perforations with clips (through-the-scope or cap-mounted, depending on the size and shape of the perforation), as soon as possible but ideally after securing a good plane for further dissection.<\/jats:p>","DOI":"10.1055\/a-2031-0874","type":"journal-article","created":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T00:00:05Z","timestamp":1678233605000},"page":"361-389","source":"Crossref","is-referenced-by-count":189,"title":["Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review"],"prefix":"10.1055","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2691-7522","authenticated-orcid":false,"given":"Diogo","family":"Lib\u00e2nio","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Portuguese Oncology Institute \u2013 Porto, Portugal"},{"name":"MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal"},{"name":"Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7308-3295","authenticated-orcid":false,"given":"Pedro","family":"Pimentel-Nunes","sequence":"first","affiliation":[{"name":"Department of Surgery and Physiology, Faculty of Medicine, University of Porto, FMUP, Porto, Portugal"},{"name":"Gastroenterology, Unilabs, Portugal,"}]},{"given":"Barbara","family":"Bastiaansen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9994-8226","authenticated-orcid":false,"given":"Raf","family":"Bisschops","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium"}]},{"given":"Michael J.","family":"Bourke","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Westmead Hospital, Sydney, Australia"},{"name":"Western Clinical School, University of Sydney, Sydney, Australia"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8926-8967","authenticated-orcid":false,"given":"Pierre H.","family":"Deprez","sequence":"additional","affiliation":[{"name":"Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Universit\u00e9 Catholique de Louvain, Brussels, Belgium"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2242-5048","authenticated-orcid":false,"given":"Gianluca","family":"Esposito","sequence":"additional","affiliation":[{"name":"Department of Surgical and Medical Sciences and Translational Medicine, Sant\u2019Andrea Hospital, Sapienza University of Rome, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6256-0167","authenticated-orcid":false,"given":"Arnaud","family":"Lemmers","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Universit\u00e9 Libre de Bruxelles (ULB), Brussels, Belgium"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1447-224X","authenticated-orcid":false,"given":"Philippe","family":"Leclercq","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium"}]},{"given":"Roberta","family":"Maselli","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Milan, Italy. 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