Endoscopic submucosal dissection in the colorectum: present status and future prospects

Area of Science:

• Gastroenterology
• Endoscopic Surgery

Background:

• Endoscopic submucosal dissection (ESD) is effective for early gastrointestinal tumors.
• Colorectal ESD is less common due to technical difficulty, longer procedure times, and higher complication rates compared to gastric ESD.

Purpose of the Study:

• To highlight the challenges and potential benefits of colorectal endoscopic submucosal dissection (ESD).
• To discuss factors hindering widespread adoption and future directions for improving colorectal ESD.

Main Methods:

• Review of current challenges and advantages of colorectal ESD.
• Discussion of technical demands, procedure time, and complication rates.
• Exploration of alternative endoscopic treatments like endoscopic mucosal resection (EMR).

Main Results:

• Colorectal ESD presents significant technical challenges and higher complication risks.
• Most colorectal lesions can be treated with less complex methods like EMR.
• ESD offers superior en-bloc resection rates, enhancing curability and histopathological assessment.

Conclusions:

• Despite challenges, ESD provides significant therapeutic advantages for colorectal lesions requiring en-bloc resection.
• Advancements in endoscopist skills, devices, injection solutions, and traction systems are crucial for future colorectal ESD feasibility.