Endoscopic Submucosal Dissection of a Large Laterally Spreading Tumor in the Rectum is a Minimally Invasive Treatment

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Section: Discussionmentioning

confidence: 99%

Endoscopic Submucosal Dissection (Esd) for Colorectal Tumors

Saito

Sakamoto

Fukunaga

et al. 2009

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“…Carbon dioxide (CO 2 ) insufflation is necessary to reduce patient abdominal discomfort during the ESD procedure . A CO 2 regulator is available from Olympus (UCR; Olympus Medical Systems) and Fujifilm (GW‐1; Fujifilm Medical) …”

Section: Methods Of Esdmentioning

confidence: 99%

“…first started carrying out colonic ESD in the late 1990s, but such procedures were being conducted by a limited number of specialists only . As a result of the widespread acceptance of gastric and esophageal ESD, the number of medical facilities carrying out colorectal ESD has been growing and its effectiveness has been increasingly reported in recent years …”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11] As a result of the widespread acceptance of gastric and esophageal ESD, the number of medical facilities carrying out colorectal ESD has been growing and its effectiveness has been increasingly reported in recent years. [12][13][14][15][16][17] However, this procedure is seldom carried out in Western countries because of technical difficulty, lack of comparative outcomes and the associated health-care costs between different modalities of treatment. Consequently, further technical advances and the availability of a suitable clinical training system are required for the extensive use of colorectal ESD.…”

Section: Introductionmentioning

confidence: 99%

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Colorectal endoscopic submucosal dissection: Technical advantages compared to endoscopic mucosal resection and minimally invasive surgery

Saito

Yamada

et al. 2013

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Background and Aim:In recent years, the effectiveness of colorectal endoscopic submucosal dissection (ESD) has been increasingly reported. Herein, we highlight the most recent developments and technical advantages of colorectal ESD compared to EMR and minimally invasive surgery.Methods: All candidate lesions for ESD were confirmed as being intramucosal tumors by colonoscopy. Presently, the indications for colorectal ESD approved by the Japanese government's medical insurance system are early colorectal cancers with a maximum tumor size of 2-5 cm; however, many early cancers >5 cm have been treated by ESD in referral centers. Results:The primary advantage of ESD compared to endoscopic mucosal resection (EMR) is a higher en-bloc resection rate for large colonic tumors that had previously been treated by surgery. ESD has several advantages compared to other therapeutic modalities, such as being a safer technique and providing better quality of life. For rectal cancer treatment, a longer procedure time is required for laparoscopic assisted colectomy, whereas trans-anal resection and trans-anal endoscopic microsurgery are more invasive than ESD with a significantly higher recurrence rate. Accordingly, ESD is the preferred choice for early colorectal cancers when there is no risk of lymph-node metastasis. Conclusion:ESD is an effective procedure for treating noninvasive non-polypoid colorectal tumors. These tumors may be difficult to resect en bloc by conventional EMR. The use of ESD results in a higher en-bloc resection rate and is less invasive than surgery.

“…ESD have advantages of a higher en bloc resection rate, a lower local recurrence rate and more accurate pathological estimation than conventional endoscopic mucosal resection (EMR) even in the colorectum, although substantial procedural risks such as perforation are reported. [3][4][5][6][7][8][9][10][11] We should sufficiently take into consideration the anatomical and histological differences between the upper and lower GI tracts, and therefore, a more careful attitude is necessary for the introduction of colorectal ESD than that of stomach ESD.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Colorectal Endoscopic Submucosal Dissection by the Trainee Endoscopists

Niimi¹,

Fujishiro²,

Goto

et al. 2012

The colorectum is known to be the most difficult organ to perform endoscopic submucosal dissection (ESD), however, the training has not been sufficiently established. In our hospital, the essential condition to start colorectal ESD was to experience at least 30 gastric ESD and to have sufficient knowledge and techniques beforehand. Rectal ESD were initially performed under supervision of ESD experts. According to their technical acquisition, the ESD experts allocated lesions to the trainees from smaller lesions in the distal colon to larger lesions in the proximal colon. We retrospectively investigated the outcomes of 92 and 23 colorectal ESD performed by two trainee endoscopists (A/B) who gained experience on our training scheme. The rates of en bloc/complete resection for A and B were 92.4%/73.9% and 95.7%/65.2%, respectively. The rates of bleeding/perforation, which occurred only with A, were 1.1%/3.3%, respectively. Intraoperative perforation occurred in one case (4.3%) in the later period. In the later period, en bloc resection rate remained high in spite of the difficult lesions. Our training scheme enabled trainees to perform colorectal ESD effectively and safely from the initial period.Step-by-step accumulation of cases such as from the rectum to the colon may be desirable for the introduction of colorectal ESD.