Endoscopic Submucosal Dissection for Colorectal Neoplasia

Abstract

Colorectal endoscopic submucosal dissection (ESD) can achieve high rate of complete resection for large colorectal neoplasia because of its possibility of en bloc resection even in large colorectal tumors. Due to this advantage and because of necessity for en bloc resection in case of early colorectal cancers, the most important indication for colorectal ESD is considered large, suspected early colorectal cancers which cannot be resected en bloc by conventional endoscopic resection methods. Although colorectal ESD has its definite role in management of large early colorectal cancers, it has not yet been widely accepted in clinical practice because of technical difficulty, long procedure time, and high rate of complications including perforation. Therefore, since its first introduction in gastrointestinal endoscopy societies, lots of trials for more effective colorectal ESD have been attempted, and newer devices and newer techniques such as pocket creation method have been suggested. Basic principles and advanced techniques for colorectal ESD and its clinical outcomes will be discussed in this chapter.