Endoscopic Submucosal Dissection (ESD) Market By Product Type (ESD Knives, Injection Agents, Electrosurgical Units, Traction Devices, Visualization Systems); By Indication (Stomach Cancer, Esophageal Cancer, Colorectal Cancer, Others); By End User (Tertiary Hospitals, Cancer Centers, ASCs, Training Institutes); By Geography, Segment Revenue Estimation, Forecast, 2024–2030

Introduction And Strategic Context

The Global Endoscopic Submucosal Dissection (ESD) Market represents a highly specialized yet rapidly expanding segment of the gastrointestinal (GI) endoscopy landscape. Endoscopic Submucosal Dissection is a minimally invasive technique developed for the en bloc resection of large and early-stage gastrointestinal tumors, especially in the esophagus, stomach, and colon. Initially developed in Japan, ESD has gained significant traction globally due to its curative potential, reduced need for open surgery, and ability to preserve organ integrity.

 

In 2024, the global ESD market is estimated to be valued at approximately USD 418.6 million, and is projected to reach around USD 722.9 million by 2030, growing at a CAGR of 9.5% over the forecast period. This growth is primarily driven by increasing incidence of early GI cancers, rising awareness of organ-preserving alternatives to surgery, technological innovation in electrosurgical and dissection tools, and training dissemination beyond Japan and Korea.

 

The rising prevalence of gastric and colorectal cancer — particularly in aging populations — is a critical driver. According to GLOBOCAN 2023, colorectal cancer is the third most diagnosed cancer globally, while gastric cancer remains a major burden in East Asia. ESD enables curative resection in these early cancers without lymph node involvement, offering lower morbidity and shorter hospital stays compared to traditional surgery.

 

Technological enablers have also played a pivotal role. The evolution of endoscopic knives, traction devices, hybrid ESD tools, and submucosal injection agents has enhanced the precision and safety of ESD procedures. “Newer ESD platforms are focusing on reducing learning curves and complication rates — key to Western market penetration,” notes a GI oncologist from the Cleveland Clinic.

 

Key stakeholders in this market include:

• Endoscopy equipment manufacturers and OEMs : Companies driving R&D and bundled product offerings.

• Hospitals and cancer centers : Core procedural hubs for early GI tumor management.

• Gastroenterologists and surgical endoscopists : End-users shaping procedural demand and adoption.

• Training academies and global endoscopy societies : Catalysts for ESD technique dissemination.

• Regulatory bodies : Influencing device approvals and regional procedural access.

• Investors and medtech VCs : Supporting startups in hybrid resection, AI-assisted navigation, and robotic ESD platforms.

While Japan and South Korea remain global pioneers, the technique is gradually expanding in Europe, China, and the United States, supported by clinical guidelines and an expanding body of ESD-trained endoscopists. Nonetheless, the market still faces limitations such as high technical complexity, long procedure times, and limited reimbursement outside Asia.

 

In the coming years, ESD’s value proposition will increasingly be shaped by adjunctive technologies (e.g., traction systems, integrated AI endoscopy) and procedural efficiency, as it competes with other techniques like EMR, full-thickness resection, or minimally invasive surgery.

 

Market Segmentation And Forecast Scope

The global endoscopic submucosal dissection (ESD) market is segmented along four key axes: Product Type, Indication Area, End User, and Region. These categories reflect both clinical complexity and market dynamics, offering granular insights into procurement patterns, clinical utilization, and growth drivers across the GI oncology continuum.

By Product Type

ESD procedures rely on a combination of advanced dissection tools and accessory systems, including specialized energy-based devices and support equipment that enable safe submucosal access and tumor resection.

• ESD Knives and Dissection Tools : This includes IT knives, dual knives, hook knives, and hybrid knives used for precise mucosal incision and submucosal dissection.

• Injection Solutions and Agents : These are injected into the submucosa to lift the lesion and create a safe dissection plane (e.g., sodium hyaluronate, glycerol).

• Electrosurgical Units (ESUs) : Advanced energy platforms enabling cutting, coagulation, and hemostasis during dissection.

• Traction Devices and Caps : These improve visualization and tissue exposure, especially in challenging anatomical locations.

• Endoscopy Towers and Visualization Systems : Support the overall procedure with high-definition imaging and real-time navigation.

In 2024, ESD knives and dissection tools account for over 38% of the market revenue, reflecting their indispensable role and recurring usage pattern.

 

By Indication Area

The ESD technique is applied to a range of early-stage gastrointestinal cancers. The choice of indication depends on tumor location, size, and regional oncological practices.

• Stomach Cancer (Gastric Lesions) : Originally developed for early gastric cancer — still the largest clinical application, especially in Asia.

• Esophageal Cancer : Increasingly used for high-grade dysplasia or superficial squamous cell carcinoma.

• Colorectal Cancer : Gaining traction for rectal and colon lesions not suitable for EMR.

• Others (Duodenum, Barrett’s Esophagus, Subepithelial Tumors)

Colorectal cancer is projected to be the fastest-growing application , particularly in the U.S., China, and Europe — with an expected CAGR of over 11.2% from 2024 to 2030.

 

By End User

ESD is primarily performed in specialized settings due to its technical complexity and risk profile.

• Tertiary Hospitals & Academic Medical Centers : Major hubs for ESD, especially in Asia and select European countries.

• Cancer Specialty Centers : Dedicated GI oncology programs with experienced endoscopists.

• Ambulatory Surgical Centers (ASCs) : Limited penetration, emerging only in high-volume, lower-risk colorectal procedures.

• Training Institutes and Endoscopy Labs : Secondary market, particularly for simulation-based or animal model ESD training kits.

Hospitals and academic centers dominate the market due to the need for on-site anesthesia, multidisciplinary backup, and endoscopic expertise.

 

By Region

• North America

• Europe

• Asia Pacific

• LAMEA (Latin America, Middle East, and Africa)

Each region reflects a different stage of ESD adoption — from mature reimbursement-backed systems (Japan, South Korea) to emerging trial-and-train environments (India, Brazil, Middle East).

This segmentation not only reflects the clinical and technological facets of the market but also highlights areas where training initiatives, digital innovation, or cost optimization could unlock further procedural expansion.

 

Market Trends And Innovation Landscape

The endoscopic submucosal dissection (ESD) market is witnessing rapid innovation aimed at improving procedural safety, expanding clinical indications, and democratizing the technique beyond high-expertise centers. As GI cancer detection improves globally and organ-preserving therapies gain prominence, ESD is evolving into a more accessible, tech-enhanced platform supported by hybrid tools, robotics, and digital augmentation.

1. Hybrid ESD Techniques and Multi-Function Tools

One of the most important trends in the ESD landscape is the development of hybrid ESD tools — devices that combine submucosal injection, incision, dissection, and hemostasis in a single instrument.

• These tools are designed to reduce scope exchanges, shorten procedure time, and flatten the learning curve.

• Recent launches include water-jet knives, grasping-type scissors, and needle-type devices with integrated injection ports.

“Combining injection, cutting, and coagulation into one instrument has streamlined the procedure — especially for colorectal lesions where scope repositioning is difficult,” said a Japanese endoscopist during the 2023 ESGE ESD workshop.

 

2. Advanced Traction and Visualization Systems

Traction systems are critical for improving exposure of the submucosal plane, especially in anatomically challenging areas like the colon. Innovations include:

• Magnetic traction systems and clip-with-line methods

• Transparent caps and dual-channel scopes to enhance access

• New endoscopic hoods that allow continuous dissection with fewer scope manipulations

These tools are improving safety, reducing perforation risk, and allowing more complex lesions to be treated by intermediate-level endoscopists.

 

3. AI and Digital Navigation in GI Endoscopy

While AI in ESD is still emerging, integration with real-time decision support systems is underway. Current applications include:

• AI-assisted lesion characterization (e.g., invasion depth, margin demarcation)

• Digital overlays during dissection to guide cutting planes

• Automated documentation and procedural metrics

AI is expected to reduce procedural variability, assist in training new endoscopists, and promote global standardization of ESD.

 

4. Training and Simulation Technologies

Training remains the biggest barrier to global ESD adoption. To address this, several companies and academic institutions are developing:

• Ex-vivo animal models and 3D-printed ESD simulators

• Virtual reality (VR) training modules for tactile skill development

• Global mentorship platforms linking Asian experts to Western learners via teleproctoring

This trend is driving a new generation of endoscopists in the U.S., Europe, and Southeast Asia to incorporate ESD into their practice, particularly for colorectal neoplasia.

 

5. M&A and Global Partnerships

Industry players are actively acquiring or collaborating with tech innovators to expand their ESD portfolios:

• Olympus partnered with Arc Medical Design to enhance its traction accessory offerings

• Medtronic is exploring AI-guided GI systems via partnerships with digital health firms

• Boston Scientific has invested in hybrid ESD toolkits to support procedural bundling with its imaging platforms

These moves reflect a trend toward consolidated ESD ecosystems — where energy delivery, visualization, and accessories are offered as integrated solutions.

As ESD continues its transition from a niche, expert-only procedure to a digitally supported, globally deployable technique, the innovation landscape is poised to shift from “can we do it?” to “how do we scale it safely?”

 

Competitive Intelligence And Benchmarking

The endoscopic submucosal dissection (ESD) market is moderately consolidated, dominated by a small group of global medtech giants with deep portfolios in endoscopy and electrosurgical platforms. However, a new wave of niche players and startups is emerging, focused on next- generation knives, AI guidance, and procedural training tools. Competition is increasingly shaped by technological differentiation, clinical education programs, and regional penetration strategies.

1. Olympus Corporation

Olympus is the undisputed global leader in the ESD segment, owing to its broadest portfolio of dissection knives, endoscopic imaging systems, and electrosurgical units. The company also leads in training initiatives across Asia, Europe, and the U.S.

• Strategy : Ecosystem bundling — offering towers, scopes, dissection tools, and accessory kits under a single platform.

• Innovation Focus : Development of multifunctional knives, traction accessories, and HD endoscopy imaging (EVIS X1 platform).

• Global Reach : Deep penetration in Japan, South Korea, Europe, and an expanding footprint in U.S. ESD programs.

 

2. Fujifilm Holdings Corporation

Fujifilm provides advanced GI endoscopy solutions, including ESD-capable scopes, dissection knives, and hybrid imaging systems (e.g., Linked Color Imaging). Its competitive edge lies in scope flexibility and traction support devices.

• Strategy : Procedural support + clinician training via Fujifilm Endoscopy Training Centers.

• Differentiation : Real-time contrast enhancement and ergonomic handle design in ESD tools.

• Markets : Strong presence in Europe and Asia-Pacific ; gaining traction in select U.S. centers.

 

3. Boston Scientific Corporation

Boston Scientific has expanded into the ESD space via accessory development, offering injectors, electrosurgical knives, and resection systems integrated with its imaging platforms. It focuses on comprehensive GI oncology solutions rather than standalone tools.

• Strategy : Portfolio synergy across polypectomy, EMR, and ESD.

• Reach : North America, select EU markets, and emerging deployments in India and China.

• Strength : Positioned as a hybrid resection partner for large colorectal lesions.

 

4. Erbe Elektromedizin GmbH

A global specialist in electrosurgery, Erbe manufactures the VIO platform, widely used in ESD for its precise energy delivery and cutting-coagulation modes.

• Strategy : Focused innovation in energy control for fine-tissue resection.

• Differentiation : Intelligent waveform customization to reduce thermal injury.

• Global Penetration : Strong in Europe, Japan, and academic GI centers worldwide.

 

5. Medtronic plc

While not traditionally a core ESD device manufacturer, Medtronic has entered the space through strategic partnerships and AI-based endoscopy platforms. Its ambitions lie in digital navigation and robot-assisted endoluminal procedures.

• Strategy : Long-term positioning in AI-enhanced GI surgery and early detection.

• Focus Areas : Colonoscopy AI (GI Genius), potential hybrid ESD integration.

 

6. Ovesco Endoscopy AG

A specialist in endoluminal therapeutic devices, Ovesco offers traction systems, closure tools, and training kits tailored for complex resections like ESD and EFTR.

• Strategy : Focused on advanced resection and defect management.

• Strength : Strong innovation pipeline in magnetic traction and OTSC closure systems.

• Key Regions : Germany, France, Switzerland, and select teaching hospitals globally.

 

7. Steris Endoscopy (formerly US Endoscopy)

Steris offers a suite of accessories and irrigation solutions that support ESD workflows. While not a knife manufacturer, it plays a vital role in scope hygiene, injection tools, and training adjuncts.

• Strategy : Ancillary product support across GI resection and procedural safety.

• Presence : Mainly in U.S. and Latin America.

Across the board, successful players are those that not only offer cutting-edge tools but also provide education, bundled solutions, and clinical partnerships. As ESD procedures move Westward, training capabilities and ease-of-use innovation will increasingly define competitive advantage.

 

Regional Landscape And Adoption Outlook

The endoscopic submucosal dissection (ESD) market exhibits significant regional disparity, largely reflecting differences in training availability, healthcare infrastructure, cancer screening policies, and reimbursement support. While Asia Pacific dominates in procedural volume and technical maturity, other regions like North America and Europe are entering a critical expansion phase, driven by early GI cancer detection and the growing demand for organ-preserving procedures.

Asia Pacific

Asia Pacific remains the epicenter of ESD adoption, led by Japan and South Korea, where the technique originated and is routinely performed in high-volume tertiary centers.

• Japan : ESD is the standard of care for early gastric and esophageal cancers. National insurance covers both procedures and tools. Japanese centers report some of the lowest complication rates globally, thanks to advanced training systems and refined devices.

• South Korea : A close second in maturity, with widespread use in gastric and rectal lesions. South Korea’s national cancer screening program has boosted early detection rates.

• China : Rapid growth, with more than 300 centers performing ESD and government support for oncology infrastructure and domestic tool manufacturing.

• India and Southeast Asia : Still in early adoption, with a few centers offering ESD, primarily for colorectal lesions. Adoption is limited by costs, device availability, and training gaps.

Asia Pacific accounted for over 52% of global ESD procedures in 2023 and will continue to lead the market in volume and innovation.

 

North America

The U.S. and Canada represent high-potential but underpenetrated markets. Uptake is growing steadily due to increasing awareness of ESD's organ-sparing advantages and clinical trial data supporting safety in colorectal and esophageal lesions.

• United States :

  • Performed mainly in academic centers (e.g., Mayo Clinic, MD Anderson).

  • Limited to select indications due to longer procedure time and absence of national reimbursement codes.

  • Growing demand in early esophageal cancer and rectal neoplasia, with ASGE and ACG publishing ESD inclusion guidelines.

• Canada : Moderate adoption in major centers like Toronto and Vancouver, but hampered by device import costs and lack of standardized training.

With increasing demand for advanced GI resection and training of U.S. gastroenterologists abroad, the region is poised for double-digit growth , especially in colorectal ESD.

 

Europe

Europe shows fragmented but promising adoption, with certain countries (e.g., Germany, France, the UK) leading ESD implementation, while others remain cautious.

• Germany & France : Among the most advanced in Europe, with routine colorectal and gastric ESD in university hospitals.

• United Kingdom : Growing use for Barrett’s esophagus and early esophageal lesions. NHS has funded training fellowships with Japanese centers.

• Italy & Spain : Active societies like ESGE are promoting ESD workshops and simulation-based learning.

Barriers include time-intensive procedures, training deficits, and reimbursement variability across public health systems.

 

LAMEA (Latin America, Middle East, and Africa)

This region represents white space with highly limited ESD penetration, due to both cost constraints and lack of local expertise.

• Brazil : The most active LATAM country for ESD, with early-stage adoption in public and private hospitals. Still relies on imported devices.

• Mexico & Argentina : Emerging awareness but minimal practice.

• Middle East : Pockets of ESD in the UAE and Saudi Arabia, driven by private hospital chains and collaborations with European surgeons.

• Africa : Virtually no access to ESD — limited to pilot procedures under academic collaboration.

“Training and cost-effective device availability remain the two critical barriers for this region,” noted a Middle East-based GI society leader in 2023.

In summary, while Asia Pacific leads in maturity and procedural volume, Europe and North America offer the highest commercial potential, particularly as training ecosystems expand and reimbursement frameworks evolve. Emerging markets in Latin America and MENA will require localized innovation and public-private collaborations to unlock adoption.

 

End-User Dynamics And Use Case

The endoscopic submucosal dissection (ESD) market is largely driven by specialized clinical settings due to the procedure’s high complexity, long learning curve, and advanced instrumentation needs. Adoption varies across end-user environments based on training access, infrastructure, and procedural reimbursement. While tertiary hospitals currently dominate, future expansion is expected into high-volume GI centers and hybrid ambulatory settings, particularly for colorectal applications.

Tertiary Hospitals and Academic Medical Centers

These institutions are the primary sites of ESD procedures, given their access to multidisciplinary teams, anesthesia support, and onsite training capabilities.

• Use Profile :

  • Complex lesions (esophageal, gastric, rectal)

  • Combined endoscopy-surgery programs

  • Focus on curative resections and clinical trials

• Procurement Behavior :

  • Favor bundled solutions from players like Olympus and Fujifilm

  • Require robust service support and device reprocessing infrastructure

 

Cancer Specialty Centers

These facilities are increasingly integrating ESD into early-stage oncology protocols, particularly for Barrett’s esophagus, intramucosal carcinoma, and large laterally spreading tumors (LSTs) in the colon.

• Focus on organ preservation, often using ESD as an alternative to segmental colectomy or esophagectomy

• Preference for digital visualization systems and traction tools for safety

 

Ambulatory Surgical Centers (ASCs)

Though still rare, some high-volume ASCs in the U.S. and Japan are incorporating colorectal ESD procedures, especially for patients unfit for surgery.

• Key enablers:

  • Use of conscious sedation protocols

  • Advances in shorter-duration ESD tools

  • Cost-control focus encouraging outpatient curative interventions

Barriers include regulatory hurdles, lack of onsite pathology, and emergency care limitations.

 

Endoscopy Training Institutes

This growing end-user segment plays a pivotal role in global ESD dissemination. These centers use:

• Simulation models (ex vivo, VR-based)

• Proctoring platforms and international fellowships

• Hands-on cadaveric or porcine labs

Manufacturers often partner with these institutes to promote tool usage, brand loyalty, and curriculum standardization.

 

Real-World Use Case Scenario

A leading academic hospital in Madrid, Spain launched an ESD training program in partnership with a Japanese university. Over 18 months, 10 advanced endoscopists were trained on colorectal ESD using hybrid knives and real-time traction techniques.

Results:

• Procedural success rate: 92% en bloc resection

• Complication rate: <4% (perforation and bleeding)

• Hospital stay reduced by 2–3 days compared to laparoscopic alternatives

• Patients preferred ESD due to no external scarring and faster recovery

This scenario demonstrates how training investments and international partnerships can rapidly elevate procedural quality and market potential in emerging ESD geographies.

 

Recent Developments + Opportunities & Restraints

The global endoscopic submucosal dissection (ESD) market has experienced notable momentum in the past two years, with advancements in product innovation, regulatory approvals, training frameworks, and international collaborations. These developments underscore the increasing recognition of ESD as a viable and preferred alternative to surgery for early-stage gastrointestinal neoplasms.

Recent Developments (2022–2024)

• Olympus launched a multifunctional ESD knife in Europe (2023)
  Designed to combine injection, incision, and coagulation functionalities, this new tool streamlines workflow and reduces procedure time in colorectal ESD.

• Fujifilm’s ELUXEO Ultra Imaging Platform approved for expanded GI use (2023)
  Enhanced digital contrast and real-time tissue characterization tools now aid ESD margin visualization and submucosal dissection plane guidance.

• Boston Scientific acquired Obsidio , Inc. (2022)
  Though primarily for embolization technology, this acquisition complements Boston’s GI resection pipeline as it explores cross-specialty innovation, including AI-guided resection planning.

• ASGE launched global tele-mentorship program for ESD (2023)
  Partnering with Japanese and European centers, ASGE has introduced a structured online curriculum for U.S.-based endoscopists to learn ESD remotely with virtual case observation.

• Korean startup EndoGlo gained CE Mark for its traction and tissue lifting system (2024)
  The system enables magnetic traction-assisted ESD with fewer complications, making it suitable for early adopters in Western Europe.

 

Opportunities

• Training-Driven Expansion in the U.S. and EU
  With rising investments in simulation, mentorship, and overseas fellowships, ESD adoption is poised to accelerate in tertiary centers outside Asia, especially for colorectal indications.

• Cost-Effective Innovation for Emerging Markets
  Companies developing reusable knives, affordable injection agents, and simplified traction systems can tap demand in India, Southeast Asia, and LATAM.

• AI and Robotic Integration
  Future ESD platforms integrating AI-assisted dissection navigation, real-time risk alerts, and robotic endoscopy arms could reduce skill dependency and widen access.

 

Restraints

• High Technical Complexity and Limited Operators
  ESD remains a niche skill set, and even in developed countries, fewer than 10% of GI endoscopists are trained to perform it — significantly limiting procedural volume.

• Regulatory and Reimbursement Gaps
  In countries like the U.S., absence of dedicated billing codes, long procedure time, and lack of bundled reimbursement discourage widespread adoption.

 

7.1. Report Coverage Table

Report Attribute	Details
Forecast Period	2024 – 2030
Market Size Value in 2024	USD 418.6 Million
Revenue Forecast in 2030	USD 722.9 Million
Overall Growth Rate	CAGR of 9.5% (2024–2030)
Base Year for Estimation	2024
Historical Data	2019 – 2023
Unit	USD Million, CAGR (2024–2030)
Segmentation	By Product Type, By Indication, By End User, By Region
By Product Type	ESD Knives, Injection Agents, Electrosurgical Units, Traction Devices, Visualization Systems
By Indication	Stomach Cancer, Esophageal Cancer, Colorectal Cancer, Others
By End User	Tertiary Hospitals, Cancer Specialty Centers, ASCs, Training Institutes
By Region	North America, Europe, Asia-Pacific, Latin America, Middle East & Africa
Country Scope	U.S., Japan, South Korea, Germany, China, India, Brazil, UAE, etc.
Market Drivers	Early cancer detection, organ-preserving alternatives to surgery, expansion of training programs
Customization Option	Available upon request