What are the latest developments in colorectal endoscopic submucosal dissection?

Abstract

Endoscopic submucosal dissection (ESD) enables direct submucosal dissection so that even large early-stage gastrointestinal tumors can be resected en bloc . ESD has recently been applied to the colorectum since it was originally developed for use in the stomach. However, colorectal ESD is technically more difficult with an increased risk of perforation compared with gastric ESD. In addition, this procedure is seldom performed in Western countries. Consequently, further technical advances and the availability of a suitable clinical training system are required for the extensive use of colorectal ESD. In this topic highlight, we review the most recent developments in colorectal ESD.

Treatment of large colorectal neoplasms by endoscopic submucosal dissection

“…On the basis of a Japanese learning curve analysis, performing 30-40 treatments in the stomach is considered sufficient for becoming skillful enough to safely perform ESD in the colon. However, because in Europe fewer early neoplastic lesions are detected in the upper gastrointestinal tract, the European Expert Panel [10] and some Japanese researchers [20] suggest starting treatments in the rectum sooner because the rectum offers easy access, easy maneuvering of the endoscope, greater wall thickness, and a retroperitoneal location. In this study, the endoscopist began performing treatments in the rectum during the same period in which he performed seven ESD treatments in the stomach; following this, ESD procedures were performed in parallel in the upper gastrointestinal tract and in the rectum, and subsequently in the proximal parts of the colon.…”

Dexmedetomidine versus midazolam for gastrointestinal endoscopy: A meta‐analysis

“…Therefore, the cost of dexmedetomidine is 37‐fold greater than that of midazolam. ERCP and ESD require a high level of technical expertise as well as a longer operation time . Sedation required for ERCP or ESD is deeper than that for conventional endoscopic procedures.…”

“…ERCP and ESD require a high level of technical expertise as well as a longer operation time. [25][26][27] Sedation required for ERCP or ESD is deeper than that for conventional endoscopic procedures. Therefore, dexmedetomidine could be a useful alternative to midazolam when carrying out ERCP or ESD, despite its high cost.…”

Oncological outcomes after endoscopic removal of malignant colorectal polyps

“…We recognize the long learning curve on ESD, but these results justify some efforts as is being done for early gastric cancer. The rectum is a safe and easier place for beginners (31)(32)(33), additionally it is the origin of significant surgical complications as we described, thus avoiding unnecessary morbidity would be highly valuable. This would also allow an immediate and adequate orientation of specimen and a better evaluation of tumor architecture, depth, lymphovascular and perineural invasion, budding, vertical and horizontal margins, and a consequent increased experience of our pathology colleagues (34).…”