Endoscopic Submucosal Dissection for Colorectal Neoplasms: Is the West Catching Up?

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Cancer Screening

Background:

• Endoscopic submucosal dissection (ESD) offers superior en bloc resection for superficial colorectal neoplasms compared to endoscopic mucosal resection (EMR).
• Western adoption of ESD has lagged due to a steep learning curve, longer procedure times, and limited training, despite its long-standing use in East Asia.
• Recent Western multicenter studies and landmark trials like RESECT-COLON show outcomes approaching those from high-volume Eastern centers.

Purpose of the Study:

• To review the current status of colorectal ESD in Western practice.
• To examine the evolution of outcomes, training, guidelines, and technology.
• To discuss strategies for bridging the East-West outcome gap and establishing ESD as a first-line therapy.

Main Methods:

• Review of recent Western multicenter studies and landmark randomized trials (e.g., RESECT-COLON).
• Analysis of evolving training paradigms, technological innovations (traction-assisted devices, AI-guided systems), and updated societal guidelines (AGA, ASGE, ESGE).
• Critical appraisal of the East-West outcome disparity in colorectal ESD.

Main Results:

• Evidence supports ESD's superiority over piecemeal EMR for large colorectal polyps.
• Western outcomes are increasingly comparable to high-volume Eastern centers.
• Novel training, technology, and guidelines are accelerating ESD adoption in the West.

Conclusions:

• Colorectal ESD is becoming a viable first-line therapy for appropriate lesions in Western endoscopy.
• Bridging the East-West outcome gap requires continued focus on training, technology, and guideline implementation.
• Further research and standardization are needed to optimize colorectal ESD in Western practice.