Editorial
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. Apr 14, 2010; 16(14): 1688-1695
Published online Apr 14, 2010. doi: 10.3748/wjg.v16.i14.1688
Safe procedure in endoscopic submucosal dissection for colorectal tumors focused on preventing complications
Naohisa Yoshida, Nobuaki Yagi, Yuji Naito, Toshikazu Yoshikawa
Naohisa Yoshida, Nobuaki Yagi, Yuji Naito, Toshikazu Yoshikawa, Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto 602-8566, Japan
Naohisa Yoshida, Center for Digestive and Liver disease, Nara City Hospital, Nara 630-8305, Japan
Author contributions: Yoshida N performed manuscript preparation and review; Naito Y and Yagi N performed the manuscript; Yoshikawa T was mentor and performed the manuscript.
Correspondence to: Naohisa Yoshida, MD, PhD, Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. naohisa@koto.kpu-m.ac.jp
Telephone: +81-75-2515519   Fax: +81-75-2510710
Received: December 9, 2009
Revised: January 26, 2010
Accepted: February 2, 2010
Published online: April 14, 2010
Abstract

Endoscopic submucosal dissection (ESD) is efficient for en bloc resection of large colorectal tumors. However, it has several technical difficulties, because the wall of the colon is thin and due to the winding nature of the colon. The main complications of ESD comprise postoperative perforation and hemorrhage, similar to endoscopic mucosal resection (EMR). In particular, the rate of perforation in ESD is higher than that in EMR. Perforation of the colon can cause fatal peritonitis. Endoscopic clipping is reported to be an efficient therapy for perforation. Most cases with perforation are treated conservatively without urgent surgical intervention. However, the rate of postoperative hemorrhage in ESD is similar to that in EMR. Endoscopic therapy including endoscopic clipping is performed and most of the cases are treated conservatively without blood transfusion. In blood examination, some degree of inflammation is detected after ESD. For the standardization of ESD, it is most important to decrease the rate of perforation. Adopting a safe strategy for ESD and a suitable choice of knife are both important ways of preventing perforation. Moreover, appropriate training and increasing experience can improve the endoscopic technique and can decrease the rate of perforation. In this review, we describe safe procedures in ESD to prevent complications, the complications of ESD and their management.

Keywords: Endoscopic submucosal dissection; Colorectal tumor; Perforation; Complication; Safe procedure