Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16153
Revised: May 1, 2014
Accepted: June 13, 2014
Published online: November 21, 2014
Processing time: 266 Days and 2.1 Hours
The introduction of colorectal endoscopic submucosal dissection (ESD) has expanded the application of endoscopic treatment, which can be used for lesions with a low metastatic potential regardless of their size. ESD has the advantage of achieving en bloc resection with a lower local recurrence rate compared with that of piecemeal endoscopic mucosal resection. Moreover, in the past, surgery was indicated in patients with large lesions spreading to almost the entire circumference of the rectum, regardless of the depth of invasion, as endoscopic resection of these lesions was technically difficult. Therefore, a prime benefit of ESD is significant improvement in the quality of life for patients who have large rectal lesions. On the other hand, ESD is not as widely applied in the treatment of colorectal neoplasms as it is in gastric cancers owing to the associated technical difficulty, longer procedural duration, and increased risk of perforation. To diversify the available endoscopic treatment strategies for superficial colorectal neoplasms, endoscopists performing ESD need to recognize its indications, the technical issues involved in its application, and the associated complications. This review outlines the methods and type of devices used for colorectal ESD, and the training required by endoscopists to perform this procedure.
Core tip: For treatment of superficial colorectal tumors, endoscopists should be aware of the treatment strategies including the indications, technical issues, and adverse events of each technique. The most appropriate treatment should be selected according to this information and in accordance with the accurate endoscopic diagnosis. In terms of endoscopic submucosal dissection (ESD), the most serious complication is iatrogenic perforation at a rate of < 3%. However, most of our patients with this complication did not need emergency surgery. Hence, ESD is considered a safe and appropriate procedure when performed by experienced endoscopists who have acquired the necessary technical skills through adequate training.