Vitor Nunes Arantes, MD, PhD, Adjunct Associate Professor, Chief, Endoscopy Unit, Alfa Institute of Gastroenterology, School of Medicine, Federal University of Minas Gerais, Av Professor Alfredo Balena 110, Belo Horizonte 30130100, Minas Gerais, Brazil. arantesvitor@hotmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Josué Aliaga Ramos, Service of Gastroenterology, Hospital José Agurto Tello-Chosica, Lima 15 150118, Peru
Josué Aliaga Ramos, Service of Gastroenterology, Clinica Madre Zoraida, Lima 15150118, Peru
Vitor Nunes Arantes, Endoscopy Unit, Alfa Institute of Gastroenterology, School of Medicine, Federal University of Minas Gerais, Belo Horizonte 30130100, Minas Gerais, Brazil
Vitor Nunes Arantes, Endoscopy Unit, Hospital Mater Dei Contorno, Belo Horizonte 30110062, Minas Gerais, Brazil
Co-first authors: Josué Aliaga Ramos and Vitor Nunes Arantes.
Author contributions: Aliaga Ramos J and Arantes VN designed this study, performed the research and project administration, wrote the original and final drafts, and made equal contributions to this manuscript as co-first authors; All authors approved the final manuscript. Both authors contributed equally.
AI contribution statement: No AI usage for manuscript preparation.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Corresponding author: Vitor Nunes Arantes, MD, PhD, Adjunct Associate Professor, Chief, Endoscopy Unit, Alfa Institute of Gastroenterology, School of Medicine, Federal University of Minas Gerais, Av Professor Alfredo Balena 110, Belo Horizonte 30130100, Minas Gerais, Brazil. arantesvitor@hotmail.com
Received: April 20, 2026 Revised: May 21, 2026 Accepted: June 10, 2026 Published online: September 8, 2026 Processing time: 140 Days and 1.9 Hours
Abstract
Colorectal endoscopic submucosal dissection (ESD) has emerged as a pivotal organ-preserving strategy for the management of superficial colorectal neoplasms. This review summarizes the current evidence on colorectal ESD, highlighting its indications, technical principles, clinical outcomes, limitations, and learning requirements. Careful preoperative lesion characterization using high-definition endoscopy combined with virtual chromoendoscopy and magnification, is essential for estimating invasion depth and selecting the appropriate candidate. Colorectal ESD is especially indicated for lesions requiring en bloc resection to enable precise histopathological assessment. Compared with endoscopic mucosal resection, colorectal ESD provides substantially higher en bloc and complete resection rates with markedly lower local recurrence, thereby overcoming the limitations of piecemeal resection in large lesions. In eligible patients, colorectal ESD offers a minimally invasive alternative to laparoscopic surgery, with favorable efficacy, shorter procedure-related burden, and preservation of bowel anatomy. Nonetheless, colorectal ESD operations requires a high-level of expertise and technical difficulty is mostly influenced by lesion size, submucosal fibrosis, and proximal colonic location. In addition, colorectal ESD demands structured training, appropriate case selection, and progressive experience, with rectal lesions and low-fibrosis tumors representing the most suitable starting point for novice operators. Colorectal ESD represents a cornerstone of modern therapeutic endoscopy, offering oncologic precision, organ preservation, and durable outcomes, and continues to expand its role in the management of early colorectal neoplasia.
Core Tip: Colorectal endoscopic submucosal dissection (ESD) is an established organ-preserving treatment for selected superficial colorectal neoplasms, particularly early colorectal cancer with suspected superficial submucosal invasion. International guidelines recognize ESD as the preferred technique when en bloc resection is required for accurate histopathological evaluation and curative treatment. Compared with endoscopic mucosal resection, ESD achieves higher en bloc and complete resection rates, improving assessment of invasion depth and resection margins. In appropriately selected lesions, colorectal ESD provides favorable long-term oncologic outcomes comparable to surgery while preserving the native organ through a minimally invasive approach.
