Pharyngeal endoscopic submucosal dissection: detection, technique, and considerations for Western adoption.

Background and Aims: Pharyngeal squamous cell carcinoma (SCC) is increasingly detected at earlier stages in Japan, largely due to routine image-enhanced endoscopy and systematic pharyngeal examination. Endoscopic submucosal dissection (ESD) is now a preferred minimally invasive treatment option for superficial SCC, with excellent outcomes. Despite this, the technique remains underutilized in the West, even though the incidence of pharyngeal cancer continues to rise. Methods: This review brings together current evidence on pharyngeal ESD, indications, technique, outcomes, and adverse events. Results: Across contemporary series, en bloc and R0 resection rates are consistently high, with serious adverse events occurring infrequently. Nonetheless, pharyngeal ESD involves unique challenges stemming from complex anatomy, specialized anesthesia, and specific exposure techniques. Conclusions: We highlight practical barriers limiting adoption in the West, particularly limited knowledge in optical diagnosis, and propose targeted education to close the knowledge gap. As demand increases for minimally invasive, organ-preserving treatments, pharyngeal ESD is poised to have an important role for the treatment of early pharyngeal SCC in Western practice.