Anesthesiologist's perspective on endoscopic submucosal dissection: Bridging minimally invasive surgery and enhanced recovery after surgery management.

In this article, we comment on the recent article by Fang et al. The study highlights that endoscopic submucosal dissection (ESD) offers advantages such as minimal incisions, shorter operative time, reduced bleeding, and faster patient recovery, demonstrating its strong alignment with the principles of enhanced recovery after surgery (ERAS). From an anesthesiologic perspective, ESD contributes to decreased intraoperative stress, thereby reducing opioid requirements. Simultaneously, the shorter procedure duration and minimal tissue trauma mitigate the adverse effects of deep anesthesia on circulatory and respiratory functions, leading to a more stable emergence from anesthesia and smoother endotracheal extubation. Ultimately, the minimally invasive nature of ESD is crucial for minimizing postoperative nausea and vomiting and preventing postoperative delirium. Historically, ERAS protocols have primarily focused on open and laparoscopic surgeries, with a lack of systematic ERAS guidelines for endoscopic treatments. Therefore, anesthesiology departments should take a more proactive role in the perioperative care of patients undergoing endoscopic procedures, spearheading the development of a standardized "ESD-ERAS" pathway.