Endoscopic resection has emerged as the first line therapy for pre-malignant conditions throughout the gastrointestinal (GI) tract. Resection techniques have evolved from forceps avulsion and snare polypectomy to endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). While ESD was originally developed in Japan for resection of early gastric neoplasia, its use in the East has expanded rapidly to all types of superficial neoplasia throughout the GI tract. Despite the widespread use of ESD in the East, Western adoption of the ESD technique has been lukewarm. The hesitancy to adopt ESD is multifactorial, likely secondary to concern about the increased risk of complications, procedure duration and reimbursement, as well as the long learning curve of ESD. Despite this initial hesitancy, preliminary reports of the use of ESD for the resection of superficial neoplastic lesions in the West have been encouraging. The aim of this review is to highlight the current use of ESD for superficial neoplastic lesions throughout the GI tract in the West.