The study aimed to characterise the current landscape of independent practice of Endoscopic Submucosal Dissection (ESD) in the UK. It assessed workforce characteristics, training experience, case volumes, service provision, technical approaches, and perceived barriers to training and service delivery. It also examined endoscopists’ views on the potential role of robotics in ESD.

A nationwide, cross-sectional, anonymised online survey was conducted between 1 May and 30 June 2025 among UK endoscopists independently performing upper and/or lower gastrointestinal (GI) ESD. The 43-item questionnaire was piloted by two expert ESD endoscopists. It was hosted on Qualtrics and disseminated through major professional societies, a curated database, and social media. Responses were analysed descriptively using Qualtrics and SPSS.

Twenty-eight responses were analysed. Most respondents were gastroenterologists (79%), with the remainder being upper or lower GI surgeons; 82% were male. Responses were received from across the UK, with the largest proportions from Greater London (39%) and the South East (18%). Most units were perceived as low-volume for Upper GI ESD, whereas the majority reported high-volume lower GI activity. Across all ESD sites, only a minority achieved the ESGE-recommended threshold of ≥25 procedures annually, with high-volume practice largely confined to rectal ESD. Overall, 68% had completed an advanced fellowship (commonly in the UK or Japan), and 82% had attended accredited ESD courses, often on multiple occasions. Respondents reported varied experiences across different ESD modalities during their training, including ex vivo, in vivo and human cases. Narrow Band Imaging (93%) and white light endoscopy (86%) were the most common delineation methods; colloid-based solutions (75%), epinephrine (82%), and blue dye (100%) were widely used for submucosal injection. Most respondents routinely used tunnelling (93%) and traction-assisted techniques (82%). General anaesthesia was preferred for upper GI ESD (82%), and conscious sedation for lower GI ESD (46%). Most procedures were scheduled within 1–3 months, with longer delays uncommon; 85% of respondents maintained a prospective ESD database. Reported barriers to training included heavy workload (37%), low caseload (26%), and limited institutional support (19%). Nearly all respondents (93%) believed robotics has a future role in ESD. Nearly as many expressed interest in adopting them (89%)

Independent ESD practice in the UK is delivered by a small workforce, with heterogeneous training backgrounds and case volumes often below recommended thresholds. National strategies for structured training, centralisation, and evaluation of new technologies are needed to support safe and sustainable expansion of ESD.