Endoscopic submucosal dissection for colorectal tumors

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• Endoscopic submucosal dissection (ESD) allows resection of larger colorectal tumors than conventional endoscopic mucosal resection (EMR).
• The distinct roles of ESD and EMR in treating colorectal tumors require clarification.

Purpose of the Study:

• To compare the indications and outcomes of ESD and EMR for colorectal tumors.
• To determine the optimal endoscopic resection technique based on tumor characteristics.

Main Methods:

• Retrospective analysis of colorectal tumors treated with ESD (44 tumors) and EMR (512 tumors).
• Comparison of resection rates, including one-piece resection (OPR) and complete resection (CR), between ESD and EMR.
• Identification of risk factors associated with incomplete resection.

Main Results:

• EMR was primarily used for adenomas <20 mm, achieving high OPR and CR rates.
• For tumors ≥20 mm, especially those with cancer or laterally spreading types, ESD demonstrated a significantly higher CR rate (0% positive lateral margin) compared to EMR (16% positive lateral margin).
• ESD procedures were longer and had a higher perforation risk, with 7 cases aborted due to technical issues or perforation.

Conclusions:

• ESD and EMR possess distinct characteristics for colorectal tumor treatment.
• Selection of ESD or EMR should be based on a thorough evaluation of the lesion and a careful balance of potential benefits and risks.