Colorectal endoscopic submucosal dissection: patient selection and special considerations

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• Endoscopic submucosal dissection (ESD) is a minimally invasive technique for resecting large, complex colorectal superficial neoplastic lesions.
• While established in Eastern countries, ESD adoption in Western centers faces challenges due to a steeper learning curve and higher complication rates.

Purpose of the Study:

• To review the advantages, risks, and benefits of ESD for colorectal lesions.
• To provide a rationale for appropriate lesion selection and discuss factors for successful ESD implementation in Western practice.

Main Methods:

• Review of existing literature on ESD for colorectal lesions.
• Analysis of factors contributing to successful ESD outcomes, including lesion assessment, diagnosis, and institutional experience.

Main Results:

• ESD can achieve en bloc resection with low recurrence rates and high-quality specimens, avoiding major surgery.
• Western centers have reported higher complication rates compared to Eastern centers, leading to skepticism.

Conclusions:

• Despite challenges, ESD can be safely and effectively incorporated into Western practice.
• Meticulous preprocedure assessment, appropriate patient referral, and individualized technique are crucial for successful colorectal ESD.