Alhamdulillah, I’m grateful to have recently completed my 100th Endoscopic Submucosal Dissection (ESD) case at Geisinger. This milestone means a lot to me personally and professionally. I’m deeply grateful to my mentor, Norio Fukami, whose training and mentorship during my time at Mayo Clinic played a major role in my third space journey. I also want to sincerely thank our leadership at Geisinger, Amitpal S. Johal, MD, FASGE and Harshit S. Khara, MD, FACG, FASGE, for believing in and supporting the growth of a third space endoscopy program here in central Pennsylvania. Thank you as well to my advanced endoscopy colleagues David Diehl, Brad Confer, Dema Shamoon, MD, and Molham Abdulsamad, MD , FACP for their collaboration, support, and guidance. Most importantly, this would not be possible without our incredible endoscopy nurses, technicians, anesthesia teams, pathology teams, surgical colleagues, and support staff. ESD is never a one person effort. It truly takes an experienced and committed team. ESD is a highly specialized advanced endoscopic technique that allows en bloc removal of large and complex gastrointestinal lesions, including early cancers, without traditional surgery in many cases. ESD can help preserve organs, avoid major operations such as esophagectomy or colectomy, reduce morbidity, and improve recovery for patients. Over the first 100 ESD cases at Geisinger Medical Center performed over the past 18 months, I’ve had the privilege of treating patients with challenging esophageal, gastric, duodenal, and colorectal lesions, many of whom otherwise may have required major surgery or may not have been surgical candidates at all. Bringing these advanced techniques to our community has been one of the most meaningful parts of my career so far. En bloc resection was achieved in 88% of cases with R0 resection in 85%, including 12 curative cancer resections. Still learning. Still growing. Still building.