[Learning experiences of colorectal ESD in a community general hospital]

Learning how to perform colorectal endoscopic submucosal dissection (ESD) is considered difficult because of different factors including the thin colorectal wall, poor fixation, numerous folds and flexures, and changing conditions over time. A surgeon with experience in performing 25 gastric ESDs began to perform colorectal ESD after fully communicating and consulting with the Department of Surgery and obtaining adequate informed consent. Herein, we examined the results of colorectal ESD performed for 57 lesions between July 2012 and September 2013. Moreover, we selected the first 10 cases (early-phase) and the last 10 cases (late-phase) from 33 colorectal ESD cases to compare the results between the early-phase and late-phase groups. For sites where it was difficult to perform colorectal ESD, it was possible to perform ESD by changing the detachment device, tip attachment, body position, and endoscope. As the surgeon gained experience in performing gastric ESD, the colorectal procedure in the late phase group could be performed with greater speed, and a rising learning curve was observed. An incidental event of delayed perforation occurred in 1 case, for which laparoscopic partial colectomy was performed immediately after the definitive diagnosis had been made.