Colorectal endoscopic submucosal dissection: Recent technical advances for safe and successful procedures

Table 1 Setting of high-frequency generators for colorectal endoscopic submucosal dissection using Flush Knife BT, Dual Knife, and hemostatic forceps (FD-410LR, FD-411QR)

Device	Mucosal incision	Submucosal dissection	Hemostasis
FlushKnifeBT with VIO 300D (at our institution)	Endocut I, effect 2, duration 3, interval 3	Forced coag, effect 2, 40-50 W Swift coag, effect 2, 40-50 W	Forced coag, effect 2, 40-50 W Swift coag, effect 2, 40-50 W
with ICC 200 (at our institution)	Endocut, effect 2-3, 80-120 W	Forced coag, 40-50 W Endocut, effect 2-3, 80-120 W	Forced coag, 40-50 W
DualKnife with VIO 300D[49]	Dry cut, effect 2, 30 W	Swift coag, effect 4, 30 W	Swift coag, effect 4, 30 W
with ESG-100[59]	Pulse-cut-slow, 50 W	Forced coag, effect 2	Forced coag, effect 2
Hemostatic forceps
FD-410LR with VIO 300D[11]			Soft coag, effect 5, 50 W
with ICC 200 (at our institution)			Soft coag, 80 W
with ESG-100[59]			Soft coag, 80 W
FD-411QR with VIO 300D (at our institution)			Soft coag, effect 6, 80-100 W

Table 2 Previous reports of treatment outcomes following colorectal endoscopic submucosal dissection

Ref.	Year	Country	Studydesign	No. ofcases	Tumorsize(mm)	En blocresectionrate (%)	Completeen blocresectionrate (%)	Perforation(%)	Bleeding (%)
Fujishiro et al[69]	2007	Japan	S, R	200	29.9	91.5	70.5	6	1
Tamegai et al[70]	2007	Japan	S, R	71	32.7	98.6	95.6	1.4
Hurlstome et al[29]	2007	United Kingdom	S, R	42		78.6	73.8	2.4	11.9
Taku et al[8]	2007	Japan	M, R	43				14
Zhou et al[9]	2009	China	S, R	74	32.6	93.2	89.2	8.1	1.3
Iizuka et al[71]	2009	Japan	S, R	38	39	61	58	8
Isomoto et al[64]	2009	Japan	S, R	292	26.8	90.1	79.8	8.2	0.7
Hotta et al[72]	2010	Japan	S, R	120	35	93.3	85	7.5
Niimi et al[73]	2010	Japan	S, R	310	28.9	90.3	74.5	4.8	1.6
Matsumoto et al[65]	2010	Japan	S, R	203	32.4		85.7	6.9
Yoshida et al[74]	2010	Japan	S, R	250	29.1	86.8	81.2	6	2.4
Tanaka et al[75]	2010	Japan	M, R	8303			83.8	4.8	1.6
Oka et al[76]	2010	Japan	M, R	688				3.3	1.7
Saito et al[77]	2010	Japan	M, P	1111	35	88		4.9	1.5
Kim et al[10]	2011	South Korea	S, R	108	27.6		78.7	20.4
Shono et al[78]	2011	Japan	S, R	137	29.2	89.1	85.4	3.6
Uraoka et al[79]	2011	Japan	S, R	202	39.9	91.6		2.5	0.5
Takeuchi et al[80]	2012	Japan	S, R	348	30	91.1		2.3	4.6
Probst et al[62]	2012	Germany	S, R	82	45.5	81.6	69.7	1.9	7.9
Toyonaga et al[12]	2012	Japan	S, R	1143		99.3		1.4	1.2
Homma et al[54]	2012	Japan	M, R	102	32.4	100		1
Tseng et al[81]	2013	Taiwan	S, R	92	37.2	90.2	89.1	12	0
Thorlacius et al[82]	2013	Sweden	S, R	29	26	72	69	6.9	3.4
Hülagü et al[83]	2013	Turkey	S, R	44	30	77.3		4.5	9.1
Hsu et al[84]	2013	Taiwan	S, R	50	33	86	82	6	0
Saito et al[52]	2013	Japan	S, R	806	37	90		2.8	1.9
Lee et al[85]	2013	South Korea	S, R	1000	24.1	97.5		5.3	0.4
Nakajima et al[86]	2013	Japan	M, P	816		94.5		2	2.2
Hori et al[87]	2014	Japan	S, P	247	35	93.1	92.3	2	0.4
Bialek et al[88]	2014	Poland	S, R	37	37	86.5	81.1	0	5.7
Nawata et al[56]	2014	Japan	S, R	150		98.6	91.3	0	0
Yamamoto et al[14]	2015	Japan	S, R	119	32.5	97.5	90.8	0.8	1.7

S: Single center; M: Multicenter; R: Retrospective study; P: Prospective study.

Table 3 Comparison of local recurrence rates after endoscopic mucosal resection and endoscopic submucosal dissection for removal of large colorectal tumors from previous single-center or multicenter studies

Ref.	Study design	Recurrence rate after EMR(En bloc resection with EMR)(Tumor size with EMR)	Recurrence rate after ESD(En bloc resection with ESD)(Tumor size with ESD)	P value
Saito et al[92]	S, R	14.0%; 33/228	2%; 3/145	P < 0.0001
		(33%; 74/228)	(84%; 122/145)	P < 0.0001
		(28 ± 8 mm)	(37 ± 14 mm)	P = 0.0006
Tajika et al[93]	S, R	15.4%; 16/104	1.2%; 1/85	P = 0.002
		(48.1%; 50/104)	(83.5%; 71/85)	P < 0.001
		(25.5 ± 6.8 mm)	(31.6 ± 9.0 mm)	P < 0.001
Terasaki et al[94]	S, R	8.0%; 14/176	0%; 0/56
		(39.3%; 70/178)
Lee et al[95]	S, R	25.7%; 29/113	0.8%; 2/257	P < 0.001
		(42.9%; 60/140)	(92.7%; 291/314)	P < 0.001
		(21.7 ± 3.5 mm)	(28.9 ± 12.7 mm)	P < 0.001
Oka et al[96]	M, P	6.8%; 55/808	1.4%; 10/716	P < 0.01
		(53.2%; 430/808)	(95.0%; 680/716)
		(32.8 ± 15.7 mm)	(39.6 ± 18.6 mm)	P < 0.01

S: Single center; M: Multicenter; R: Retrospective study; P: Prospective study; ESD: Endoscopic submucosal dissection; EMR: Endoscopic mucosal resection; Tumor size: Mean ± SD.