Endoscopic submucosal dissection in the colorectum: Feasibility in the Canadian setting

Area of Science:

• Gastroenterology and Endoscopic Surgery

Background:

• Endoscopic submucosal dissection (ESD) is a minimally invasive technique for gastrointestinal tumor removal.
• Its application for colonic neoplasms is increasing, aiming to preserve colon segments in select patients.
• While pioneered in Japan, ESD for colonic lesions is gaining traction in Western centers, though its use in Canada remains limited.

Purpose of the Study:

• To review the challenges and opportunities associated with colonic endoscopic submucosal dissection.
• To highlight the unique training infrastructure required for supervised practice of this procedure.
• To provide a combined Japanese and Canadian perspective on ESD for colonic neoplasms.

Main Methods:

• Review of technical aspects and clinical application of endoscopic submucosal dissection for colonic neoplasms.
• Discussion of specialized instrumentation and the critical need for meticulous technique.
• Analysis of training requirements and performance standards for ESD.

Main Results:

• Colonic ESD is technically demanding, requiring specialized tools and precise execution.
• Successful implementation necessitates dedicated training programs and a structured approach.
• The technique holds potential for selected cases, offering an alternative to traditional surgery.

Conclusions:

• Endoscopic submucosal dissection is a viable, minimally invasive option for colonic neoplasms.
• Addressing technical challenges and establishing robust training are crucial for wider adoption.
• Further exploration of indications and collaborative efforts can enhance ESD's role in colon cancer management.