Endoscopic Submucosal Dissection (ESD) in Colorectal Tumors

Area of Science:

• Gastroenterology
• Endoscopic Surgery

Background:

• Endoscopic submucosal dissection (ESD) originated in Japan for early gastric cancer.
• ESD is increasingly considered for large sessile or flat colorectal neoplasia.

Purpose of the Study:

• To review the current literature on colorectal ESD.
• To evaluate the efficacy and safety of ESD for colorectal neoplasia compared to other methods.

Main Methods:

• A comprehensive literature review of colorectal ESD was conducted.

Main Results:

• ESD achieves high en bloc resection rates and low recurrence for large colorectal neoplasia, comparable to endoscopic mucosal resection (EMR) for delayed bleeding.
• While ESD has higher perforation rates, they are often minor and treated during the procedure.
• ESD requires advanced endoscopic skills and longer procedure times but offers lower complication rates than minimally invasive surgery.

Conclusions:

• Colorectal ESD presents advantages over EMR and minimally invasive surgery for large lesions.
• Widespread adoption in Western countries is hindered by limited experience and the need for adequate training.
• Reducing procedure time through modifications is crucial for the future of colorectal ESD.