Endoscopic resection of digestive tumors: indications, quality criteria and results In the past decade, two developments have changed the approach to superficial digestive tumors: 1) new endoscopic techniques allow "en bloc" resection of superficial tumors with almost no limit in tumor diameter and 2) the risk of lymph node metastases is better stratified (e.g., in the colon, the risk of lymph node metastasis is negligible for superficial malignant invasion of the submucosa). Endoscopic submucosal dissection (ESD) allows "en bloc" resection of large laterally-spreading tumors, in contrast with prior resection techniques (endoscopic mucosal resection - EMR) that required piecemeal resection for large tumors. As a result, relapse rate is lower with ESD compared to EMR. Pathological examination is also more reliable with "en bloc" specimens; it must precisely assess resection margins and the depth of malignant invasion.