Endoscopic Submucosal Dissection for Colorectal Tumors

Park, Sang Un; Chang, Dong Kyung

Abstract

Because screening gastrointestinal endoscopies have been widely performed recently, diagnosis rates of early stage cancer have been increasing rapidly. This trend has also led to advances in therapeutic endoscopy, which is less invasive than surgery. The state-of-the-art technique, endoscopic submucosal dissection (ESD), allows more favorable outcomes than conventional endoscopic mucosal resection (EMR) regarding en-bloc resection of the lesion, irrespective of the size of the lesion. ESD has already been established as the standard therapeutic option for neoplastic lesions in the upper gastrointestinal tract. However, the use of ESD for colorectal lesions is not yet established because of the unique pathological, organ specific characteristics of colonic lesions. Moreover, endoscopists are required to have higher qualifications to perform ESD and tend to cause complications more frequently. Nevertheless, it is obvious that ESD has a therapeutic advantage for certain colonic lesions and enables endoscopists to achieve a higher en-bloc resection rate, resulting in enhanced curability and more accurate histopathological assessment. Recent development of a special colonoscope for ESD and refinement of devices such as surgical knives and traction systems are expected to overcome some limitations of ESD and a standard protocol will be available in the near future. In this review, we will discuss the current status and future prospects of colorectal ESD.