Published online Apr 16, 2019. doi: 10.4253/wjge.v11.i4.262
Peer-review started: February 10, 2019
First decision: February 19, 2019
Revised: March 17, 2018
Accepted: March 26, 2019
Article in press: March 26, 2019
Published online: April 16, 2019
Colorectal endoscopic submucosal dissection (ESD) is considered one of the most challenging endoscopic procedures for novice endoscopists. When compared with the stomach, the colon and rectum have a narrower tubular lumen, greater angulation at the flexures, and a thinner muscle layer. These factors make endoscopic control and maneuverability difficult. ESD of the colorectum was considered more difficult than gastric and esophageal ESD. However, with learning from the experts, practicing, and selecting an appropriate technique, most of colorectal ESD could be performed successfully. Nevertheless, some colorectal locations are extremely specialized either from unique anatomy or given unstable scope position. Accordingly, the objective of this review was to provide endoscopists with an overview of the techniques and outcomes associated with ESD at these special colorectal locations. ESD at the discussed special locations of the ileo-colo-rectum was found to be feasible, and outcomes were comparable to those of ESD performed in non-special locations of the ileo-colo-rectum. Practice for skill improvement and awareness of the unique characteristics of each special location is the key to performing successful ESD.
Core tip: Colorectal endoscopic submucosal dissection (ESD) involving ileocecal valve, appendiceal orifice or anal canal is considered to be extremely challenging for novice ESD endoscopist. With well-prepared strategies and appropriate assisting devices, the successful procedures with less complications can be achieved. We made great efforts to review and summarize the currently proposed techniques to overcome these difficulties.