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Review
. 2014 Feb;30(1):39-44.
doi: 10.1159/000358529.

Endoscopic Submucosal Dissection (ESD) in Colorectal Tumors

Franz Ludwig Dumoulin  1 , Bernd Sido  2 , Reinhard Bollmann  3 , Malte Sauer  1
Affiliations
Review

Endoscopic Submucosal Dissection (ESD) in Colorectal Tumors

Franz Ludwig Dumoulin et al. Viszeralmedizin. 2014 Feb.

Abstract
in English, German

Background: Endoscopic submucosal dissection (ESD) - initially developed for the treatment of early gastric cancer in Japan - is an attractive option for en bloc resection of larger sessile or flat colorectal neoplasia.

Methods: A review of the current literature on colorectal ESD was carried out.

Results: In contrast to conventional endoscopic mucosal resection (EMR), ESD for larger colorectal neoplasia yields high en bloc resection rates and very low recurrence rates. The frequency of delayed bleeding is similar for EMR and ESD. Higher perforation rates during ESD are mostly due to microperforations identified and treated during the intervention, and are therefore of minor clinical relevance. A major disadvantage of ESD is the necessity for high-level endoscopic skills and long procedure times. ESD also has the potential to replace laparoscopic surgery or transanal endoscopic microsurgery mainly due to its lower complication rates.

Conclusion: ESD for the resection of larger flat or sessile colorectal lesions has potential advantages over conventional EMR or minimally invasive surgery. Due to the low incidence of early gastric cancer, experience with ESD will remain limited in Western countries. The spread of colorectal ESD will depend on adequate training opportunities and also on modifications yielding a reduction in procedure time.

Hintergrund: Die endoskopische Submukosadissektion (ESD) wurde zur Therapie des Magenfrühkarzinoms in Japan entwickelt. Sie ist auch eine attraktive Methode zur En-bloc-Resektion größerer sessiler oder flacher kolorektaler Adenome.

Methoden: In dieser Übersicht wurde die Literatur zur kolorektalen ESD gesichtet und bewertet.

Ergebnisse: Im Gegensatz zur konventionellen endoskopischen Mukosaresektion (EMR) ermöglicht die ESD eine deutlich höhere En-bloc-Resektionsrate und weist eine geringere Rezidivrate auf. Die Anzahl der Blutungskomplikationen unterscheidet sich nicht. Die höhere Perforationsrate ist von geringer klinischer Bedeutung, da es sich meist um Mikroperforationen handelt, die bei der ESD erkannt und therapiert werden. Der wesentliche Nachteil der ESD besteht in der deutlich längeren Interventionszeit. Gegenüber minimalinvasiven chirurgischen Therapieformen weist die ESD den Vorteil der geringeren Komplikationsrate auf.

Schlussfolgerungen: Die kolorektale ESD hat Vorteile gegenüber der konventionellen EMR und auch gegenüber der minimalinvasiven Chirurgie. Aufgrund der geringen Inzidenz des Magenfrühkarzinoms wird die Erfahrung mit ESD in den westlichen Ländern begrenzt bleiben. Die Verbreitung der kolorektalen ESD wird hierzulande wesentlich von den Trainingsmöglichkeiten und auch von technischen Vereinfachungen abhängen, die eine Reduktion des Zeitbedarfs ermöglichen.

Keywords: Bleeding; Colorectal adenoma; Early colorectal cancer; En bloc resection; Endoscopic submucosal dissection; Perforation.

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Figures

Fig. 1
Fig. 1
Example of an ESD procedure: a A large sessile lesion (Paris classification 0-Is/0-IIa) was detected in the ascending colon. b Target lesion is surrounded by marking dots to facilitate resection. c Submucosal injection of 4% gelatine solution with a small amount of indigo carmine; injection is carried out with a small bore needle outside the lesion to avoid submucosal bleeding. d Opening of the submucosal space with traction on the specimen by gravity. e Subtotal preparation, and f resection area with hemoclips to prevent delayed bleeding.
Fig. 2
Fig. 2
Sample preparation and histopathological analysis. Special care is taken to correlate microscopic findings with endoscopy. Moreover, the margins of the specimen are meticulously inspected for residual adenoma/carcinoma. a ESD specimen pinned on corkboard to facilitate identification of margins. b Positioning of transverse sections. c Microscopic analysis allowing topographical correlation.
See this image and copyright information in PMC

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References

    1. Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol. 2007;18:581–592. - PubMed
    1. Pox CP, Altenhofen L, Brenner H, Theilmeier A, Von Stillfried D, Schmiegel W. Efficacy of a nationwide screening colonoscopy program for colorectal cancer. Gastroenterology. 2012;142:1460–1467. - PubMed
    1. Martinez ME, Baron JA, Lieberman DA, et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology. 2009;136:832–841. - PMC - PubMed
    1. Farrar WD, Sawhney MS, Nelson DB, Lederle FA, Bond JH. Colorectal cancers found after a complete colonoscopy. Clin Gastroenterol Hepatol. 2006;4:1259–1264. - PubMed
    1. Robertson DJ, Lieberman DA, Winawer SJ, et al. Colorectal cancers soon after colonoscopy: a pooled multicohort analysis. Gut. 2013. DOI: 10.1136/gutjnl-2012-303796. - PMC - PubMed