Endoscopic Submucosal Dissection Market Report Scope & Overview:

The endoscopic submucosal dissection market size was valued at USD 370.47 million in 2024 and is expected to reach USD 568.31 million by 2032, growing at a CAGR of 5.51% over 2025-2032.

The endoscopic submucosal dissection market is on an upswing, supported by a 27% increase in global penetration of ESD procedures and the soaring prevalence of gastrointestinal cancers (26,890 new stomach cancer cases expected in the U.S. alone in 2024), stimulating both market demand and growth dynamics. Knives represent the highest product share, followed by gastroscopes and colonoscopes. Hospitals remain primary end-users.

Advances in technology, such as AI-enhanced imaging, hybrid knives, and HD systems, help streamline the procedure while ensuring patient safety, thereby driving the market expansion. There was a significant increase in R&D investments, including robotic-assisted navigation, precision instruments, and realistic simulation models (EndoGel) to promote training and adoption among clinicians. Regulatory approvals and clinician training projects continue to build supply availability, driving utilization as procedural barriers decrease. Endoscopic submucosal dissection (ESD) market growth and shares show positive correlation over time, accompanied by a rapid surge of disease incidence, and technological advancement and learning curves serving to drive preference for gentler organ-preserving minimally invasive treatment.

Market Dynamics:

Drivers:

• Rising Clinical Adoption, Stronger Training, and Capital Inflows are Expanding Procedure Volumes and Device Innovation

Stronger clinical adoption has led to a continuous gain in procedure volumes, as more hospitals and specialty centers are adopting organ-preserving treatment for early gastrointestinal cancers, thus driving the endoscopic submucosal dissection market. As a result, ESD has become the standard treatment with which to treat early gastric cancer in most advanced healthcare systems and is performed more frequently than conventional surgery. The expansion of R&D capabilities by medical device manufacturers is spurring innovation in ESD knives, electrosurgical units, and precision accessories.

R&D is focusing on AI-assisted imaging, electrocautery-enhanced devices, and ergonomic endoscopes as it seeks to advance efficiency and safety. Swift regulatory approvals for new ESD devices are making market entry easier, increasing approval of products through hospitals and ambulatory surgical centers. Training improvements, including high-fidelity simulators and formal certification programs, are reducing the learning curve, allowing more clinicians to perform ESD safely. These two factors are fueling long-term growth of the market and will drive an increase in the global endoscopic submucosal dissection market size that has been analyzed.

Restraints:

• Procedural Complexity, Workforce Constraints, and Reimbursement Ambiguity Limit Broader Diffusion

The endoscopic submucosal dissection market is growing, but it is facing several restraints. Anatomically, it is a complex procedure and a significant training time and experience is required to perform the same, which in turn causes a bottleneck of skilled operators. Few hospitals have a formalized practical ESD training course available for their staff, which means fewer individuals are being educated. Process times are lengthy in comparison to traditional endoscopic resections, which raises procedural cost and reduces throughput daily in the high-volume endoscopy unit.

Reimbursement policies are either vague or lacking in parts of the U.S., which deters providers (especially those at lower-volume centers) from providing ESD. Device introductions can be delayed by protracted regulatory evaluations or elaborate manufacturing procedures. However, the rapid technological advances are not there yet and require a deep clinical validation to become widely accepted. Taken together, these elements combine to slow the overall pace of ESD as companies must address the potential market while leaving a wide space between available technology and its adoption into the real clinical world.

Segmentation Analysis:

By Product

Gastroscopes & colonoscopes held over 35% market share in 2024, driven by vital presence in almost all ESD procedures, coupled with HD-imaging capabilities, narrow-band imaging, and higher maneuverability for accurate resections. Adoption was boosted by market leaders providing continuous upgrades and integration with AI-assisted detection tools. The area of Knives shows the highest growth, and innovations include water-jet integrated knives, insulated tip technology, and devices that facilitate cutting and coagulation simultaneously. These developments cut procedure times and bleeding risks, and fit with the modus operandi of endoscopists who are attracted to efficiency. Growing needs for specialized ESD knives in academic and commercial endoscopy centers, mainly due to the expansion of ESD training, are expected to drive the growth in these regions.

By Indication

Stomach cancer led a market share of more than 40% in 2024 and is anticipated to grow due to the high incidence rate of early gastric cancer levels in Japan, South Korea, and China (known for their national screening programs leading to an increased level of diagnosis with treatment through ESD). The fit-for-purpose nature of its early lesion complete block resection suggests long-term demand with attention to attracting new use cases for improved utilization.

However, the fastest-growing segment, colon cancer, is primarily driven by wider colorectal cancer screening initiatives in North America and Europe and increasing acceptance of ESD over EMR for large colorectal lesions. Improved training, more effective bowel preparation methods, and the evolution of colon-specific ESD tools are supporting growth globally.

By Technology

In 2024, conventional ESD was the leading technology with about half of the total share (around 55%), particularly in countries in which it is reimbursed and payment is not capped, driven by its clinical efficacy, ability for R0 resection, and high level of physician familiarity. Several manufacturers, extensive clinical literature, and many available compatible primes help maintain its dominance.

Hybrid ESD, the most rapidly escalating technique, utilizes a combination of submucosal dissection and snare resection, resulting in an improved technical learning curve and shorter procedural times. This approach has been attractive to adopters and EMR-defected endoscopy units as it reduces risks and the need for training, while maintaining acceptable resection results. Hybrid ESD is quite common in some of the emerging countries, and more people are getting trained in it as it can be cheaper and quicker to adopt compared to new device ideas.

By End-Use

Hospitals accounted for 60% of revenue share in 2024 as these are well-equipped, high patient pool, and have in-house interdisciplinary teams needed for complex ESD cases. The seamless integration of endoscopy suites with imaging and pathology departments for optimal treatment provision has helped in enhancing favoritism by patients and healthcare providers. Favorable trends for ASCs include shorter patient length of stay, lower costs, and growing reimbursement coverage for outpatient ESD. The shift to compact, high-definition endoscopic platforms and portable electrosurgical units is also allowing an ASC to perform complex resections with safety standards similar to those of hospital-based platforms. Patient demand for minimally invasive outpatient care with quicker recovery time also continues to drive their growth.

Regional Analysis:

North America dominated the market with a large inventory of minimally invasive procedures, well-developed healthcare infrastructure, and favorable reimbursement policies.

The U.S. endoscopic submucosal dissection market size was valued at USD 123.08 million in 2024 and is expected to reach USD 174.93 million by 2032, growing at a CAGR of 4.47% over 2025-2032. The U.S. constituted the major share with a huge patient base, early adoption of AI-assisted ESD systems, and well-established training programs. Government-led cancer screening programs are increasingly being implemented in Canada, which would boost the adoption at a stable rate. Advanced endoscopy centers with integrated imaging and pathology units perform thousands of ESD procedures each year in the U.S. North America also displays the highest growth, witnessed significantly in the U.S, while supported with ongoing R&D investment and FDA approvals for novel ESD Knives & Hybrid systems.

The Asia Pacific region held the largest share of the global market and is expected to remain dominant due to higher rates of gastric cancer incidence and improved detection trends. Japan is at the helm due to its national screening policy, the quality of endoscopists available, and the depth of clinical experience. The rapid growth that was seen in China reflects the large number of cancer cases, but also the local availability of cheap ESD equipment. India, on the other hand, is the fastest-growing country due to efforts made by government departments to develop healthcare infrastructure, along with increasing patient awareness and increasing private sector investment in endoscopic training facilities. The country also boasts significant penetration owing to its world-class hospitals and government-mandated reimbursement for gastric ESD.

Key Players:

Leading endoscopic submucosal dissection companies in the market include Medwork GmbH, EndoMed Systems GmbH, Taewoong Medical Co., Ltd., US Endoscopy, Apollo Endosurgery Inc., Endo Tools Therapeutics, HOYA Technosurgical, MTW Endoskopie Manufaktur W. Haag KG, Endoaccess GmbH, ASGE, M.I. Tech Co., Ltd., Medivators Inc. (Cantel Medical), EndoClot Plus Inc., Adeor Medical AG, LocaMed Ltd., Interscope Inc., Innovex Medical Co., Ltd., Nitinol Devices & Components Inc. (NDC), Ovesco’s OVESCO Clip Technology, and Microvasive Endoscopy.

Recent Developments:

In July 2024, Olympus Corporation launched its next-generation ESD Knife J with enhanced cutting precision and integrated water jet function, designed to improve procedure speed and safety, particularly for large colorectal lesions.

In March 2024, Boston Scientific received CE Mark approval for its Hybrid ESD System, enabling combined dissection and coagulation in a single device, aimed at reducing operation time and improving patient recovery outcomes in complex GI tumor cases.