Endoscopic Submucosal Dissection of Colorectal Neoplasias – Step-by-Step Explanation, Technical Aspects

AbstractEndoscopic submucosal dissection (ESD) is becoming accepted for colorectal neoplasms (CRNs) in Japan; however, it is not widely used worldwide because of technical difficulty.Indications: Flat CRNs≥20 mm indicating estimated invasion depth of M or SM superficial, which are difficult to treat by endoscopic mucosal resection.Equipment: Needle knife and insulation-tipped knife with CO2 insufflation.Results: En bloc resection rate was 90% among 806 ESDs. Median operation time was 90 min and mean resected specimens size was 40 mm with 2.9% perforations.Conclusion: Despite longer procedure times, ESD is becoming a preferred treatment in Japan for large flat CRNs. This article is part of an expert video encyclopedia