Colorectal Endoscopic Submucosal Dissection: An Update on Best Practice

Authors

Tara Keihanian
Mohamed O Othman

Publication Date

1-1-2021

Journal

Clinical and Experimental Gastroenterology

DOI

10.2147/CEG.S249869

PMID

34377006

PMCID

PMC8349195

PubMedCentral® Posted Date

8-3-2021

PubMedCentral® Full Text Version

Post-Print

Published Open-Access

yes

Keywords

endoscopic submucosal dissection, colonic neoplasm, endoscopic mucosal resection

Abstract

Endoscopic submucosal dissection (ESD) is a method of en-bloc resection of neoplastic colorectal lesions which is less invasive compared to surgical resection. Lesion stratification, architecture recognition and estimation of depth of invasion are crucial for patient selection. Expert endoscopists have integrated a variety of classification systems including Paris, lateral spreading tumor (LST), narrow band imaging (NBI), international colorectal endoscopic (NICE) and Japanese NBI expert team (JNET) in their day-to-day practice to enhance lesion detection accuracy. Major societies recommend ESD for LST-non granular (NG), Kudo-VI type, large depressed and protruded colonic lesions with shallow submucosal invasion. Chance of submucosal invasion enhances with increased depth as well as tumor location and size. In comparison to endoscopic mucosal resection (EMR), ESD has a lowerl recurrence rate and higher curative resection rate, making it superior for larger colonic lesions management. Major complications such as bleeding and perforation could be seen in up to 11% and 16% of patients, respectively. In major Western countries, performing ESD is challenging due to limited number of expert providers, lack of insurance coverage, and unique patient characteristics such as higher BMI and higher percentage of previously manipulated lesions.