Endoscopic submucosal dissection for colorectal neoplasms: A review

Figure 1 Indication for colorectal endoscopic submucosal dissection. LST: Laterally spreading tumors; G: Granular; NG: Non-granular; ESD: Endoscopic submucosal dissection; EMR: Endoscopic mucosal resection; HB: Hot biopsy.

Figure 2 Devices used for colorectal endoscopic submucosal dissection in the National Cancer Center Hospital, Tokyo, Japan. A: Jet B knife; B: IT knife nano; C: Short-type ST hood; D: Hemostat Y.

Figure 3 Endoscopic submucosal dissection procedure. A: A flat elevated lesion (85 mm) located in the ascending colon. It was impossible to have a retroflex view of this lesion; B, C: Submucosal injection of Glyceol and the first circumferential incision were initiated from the oral side of the lesion in the forward view. The first cut was made with the Jet B knife; D: After the first circumferential incision, it was difficult to slide the top of the short-type ST hood into the submucosal layer. The next step was to broaden the visual field by cutting the blue colored submucosal layer near the mucosa carefully (white dotted line); E-G: After step D, it was easy to slide the top of the short-type ST hood into the submucosal layer; it then became easier to cut the submucosal layer. In this situation, the IT knife nano was useful for a quick dissection of the submucosal layer; H, I: En bloc resection was achieved without any adverse events within 180 min.

Figure 4 Hybrid endoscopic submucosal dissection procedure. A: Flat elevated lesion (25 mm) located in the sigmoid colon; B, C: After submucosal injection of Glyceol, a circumferential incision was made using the top of the snare; D: After an additional submucosal injection, the snaring technique was applied to achieve complete removal; E: En bloc resection was achieved with no complications; F: Mucosal defect was completely closed using metallic endoclips.