{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T16:22:58Z","timestamp":1783527778285,"version":"3.55.0"},"reference-count":105,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Endoscopic submucosal dissection (ESD) has revolutionized the management of superficial colorectal neoplasms, offering superior en bloc resection rates compared with conventional endoscopic mucosal resection (EMR). While ESD has been the standard of care in East Asian countries for over two decades, its adoption in Western countries has been considerably slower, hampered by the steep learning curve, prolonged procedural times, limited training infrastructure, and differences in disease epidemiology. However, recent years have witnessed a paradigm shift, with growing evidence from Western multicenter studies demonstrating outcomes that increasingly approach those reported from high-volume Eastern centers. The landmark RESECT-COLON randomized trial provided level-1 evidence supporting the superiority of ESD over piecemeal EMR for large colorectal polyps. Concurrently, novel training paradigms, technological innovations including traction-assisted devices and artificial intelligence (AI)-guided systems, and evolving societal guidelines from the American Gastroenterological Association (AGA), American Society for Gastrointestinal Endoscopy (ASGE), and European Society of Gastrointestinal Endoscopy (ESGE) are accelerating Western adoption. This state-of-the-art review comprehensively examines the current landscape of colorectal ESD in Western practice, highlighting the evolution of outcomes, training pathways, guideline recommendations, technological advances, and future directions. We provide a critical appraisal of the East\u2013West outcome gap and discuss strategies to bridge this divide, positioning colorectal ESD as an increasingly viable first-line therapy for appropriate lesions in Western endoscopy centers.<\/jats:p>","DOI":"10.3390\/cancers18142190","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T15:40:09Z","timestamp":1783525209000},"page":"2190","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic Submucosal Dissection for Colorectal Neoplasms: Is the West Catching Up?"],"prefix":"10.3390","volume":"18","author":[{"given":"Ishaan","family":"Vohra","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Illinois College of Medicine Peoria, Peoria, IL 61605, USA"},{"name":"Department of Gastroenterology, Carle Methodist Healthcare System, Peoria, IL 61636, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harishankar","family":"Gopakumar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Brigham and Women\u2019s Hospital, 75 Francis Street, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9517-1759","authenticated-orcid":false,"given":"Anuraga","family":"Meyyappan","sequence":"additional","affiliation":[{"name":"Department of Medicine, American University of Antigua, University Park, Jabberwock Beach Road, Coolidge P.O. Box W1451, Antigua and Barbuda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cody","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Arizona College of Medicine-Phoenix, 475 N 5th St, Phoenix, AZ 85004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrett","family":"Blatter","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Arizona College of Medicine-Phoenix, 475 N 5th St, Phoenix, AZ 85004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1175-2103","authenticated-orcid":false,"given":"Brian","family":"Martins","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Arizona College of Medicine-Phoenix, 475 N 5th St, Phoenix, AZ 85004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shyam","family":"Thakkar","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Department of Medicine, West Virginia University, 5th Floor HSCS, Room 5500, Morgantown, WV 26506, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Sharma","sequence":"additional","affiliation":[{"name":"Banner MD Anderson & BMG, Banner Health, 925 E. 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