Why is it called gastric cancer surgery without incision? This is because nowadays, early gastric cancer can be removed endoscopically in a process similar to gastroscopy, without opening the abdomen and removing the diseased tissue from outside, but directly from inside the stomach cavity. Endoscopic submucosal dissection (ESD) is a new technique based on endoscopic mucosal resection (EMR), which mainly targets early-stage GI cancer and precancerous lesions. ESD can be used for complete resection of the lesion and achieve the effect of radical treatment of GI tumors. The indications for ESD are early stage cancer with lesions limited to the mucosa and submucosa, precancerous lesions and benign polyps are also indications for ESD. Early gastric and esophageal cancers are usually detected during gastroscopy. Preoperative ultrasound endoscopy is used to determine the depth of lesion infiltration, to understand whether there are regional lymph node metastases, and to ensure the integrity of the lesion base. After clinical imaging evaluation such as CT, when the tumor is confirmed to be in early stage with small tumor and no evidence of lymph node metastasis, endoscopic resection of the tumor can be chosen. What are the advantages of endoscopic submucosal dissection? The advantages of ESD are: it can completely remove larger lesions larger than 2 cm. The treatment of early stage cancer of the digestive tract used to be mainly surgical, but it is highly invasive. As long as the operation is excellent and the case is suitable, ESD is comparable to traditional radical surgery, so the advantages of ESD are obvious: less damage, lower cost and faster postoperative recovery. How safe is endoscopic submucosal dissection? As with other endoscopic treatments, ESD carries certain risks. The main complications are bleeding and perforation, with an incidence of about 5-8%. Intraoperative bleeding can be controlled by endoscopic electrocoagulation or the use of titanium clips, and the application of hemostatic drugs before and after surgery can effectively prevent intraoperative and postoperative bleeding; perforation complicated by ESD is usually small and can usually be detected intraoperatively, and can be cured by a combination of titanium clips, postoperative gastrointestinal decompression, fasting, and prevention of infection. Matters to be noted after endoscopic submucosal dissection Patients undergoing endoscopic submucosal dissection should fast for 1-2 days after surgery, and a liquid and easily digestible diet should be used for 1 week, acid suppressing drugs, mucosal protective agents, and prevention and control of infections. The presence of abdominal distension, abdominal pain, vomiting blood, black stool, etc., and the occurrence of complications such as bleeding and perforation should be noted within 2 days after surgery. Gastroscopy should be reviewed electively within 2 months after surgery to understand the healing of the trauma and the presence of residual lesions. To have a chance of minimally invasive cure, it also depends on early detection ESD surgery is less invasive and has obvious advantages, but it also needs to strictly grasp the indications, after all, it deals with tumors and must be done once and for all. ESD is suitable for early gastric cancer with very low possibility of lymph node metastasis, and most patients do not have the chance to receive minimally invasive radical treatment because the detection rate of early gastric cancer in China is less than 10%. It is imperative to popularize gastroscopy and increase the detection rate of early gastric cancer.