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World J Gastrointest Endosc. Oct 15, 2009; 1(1): 32-38
Published online Oct 15, 2009. doi: 10.4253/wjge.v1.i1.32
Endoscopic submucosal dissection for colorectal neoplasms
Mitsuhiro Fujishiro
Mitsuhiro Fujishiro, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Author contributions: Fujishiro M is solely responsible for this article.
Correspondence to: Mitsuhiro Fujishiro, MD, PhD, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Telephone: +81-3-38155411-33019 Fax: +81-3-58008806
Received: March 3, 2009
Revised: March 31, 2009
Accepted: April 7, 2009
Published online: October 15, 2009

Although endoscopic submucosal dissection (ESD) gains acceptance as one of the standard treatments for esophageal and stomach neoplasms in Japan, it is still in the developing stage for colorectal neoplasms. In terms of indications, little likelihood of nodal metastasis and technical resectability are principally considered. Some of intramucosal neoplasms, carcinomas with minute submucosal invasion, and carcinoid tumors, which are technically unresectable by conventional endoscopic treatments, may become good candidates for ESD, considering substantial risks and obtained benefits. ESD as a staging measure to obtain histological information of the invasion depth and lymphovascular infiltration is acceptable because preoperative prediction is difficult in some cases. In terms of techniques, advantages of ESD in comparison with other endoscopic treatments are to be controllable in size and shape, and to be resectable even in large and fibrotic neoplasms. The disadvantages may be longer procedure time, heavier bleeding, and higher possibility of perforation. However, owing to refinement of the techniques, invention of devices, and the learning curve, acceptable technical safety has been achieved. Colorectal ESD is very promising and become one of the standard treatments for colorectal neoplasms in the near future.

Keywords: Colorectal neoplasm, Early colorectal cancer, Endoscopic submucosal dissection, Endoscopic mucosal resection, Endoluminal surgery