Is esophageal endoscopic submucosal dissection an extreme treatment modality, or can it be a standard treatment modality?

Endoscopic submucosal dissection (ESD) has been applied to, and gradually standardized for, early gastric cancers; however, it has not yet been widely used for treatment of colorectal neoplasms. Compared with gastric ESD, the thinner colorectal wall and winding nature of the colon make colorectal ESD a much more difficult operative technique. Despite greater risks of postoperative complications, particularly perforation of the colon, more and more endoscopists are making an effort to study this new technique in terms of its capability of larger neoplastic resection, higher en bloc resection rate and lower local recurrence rate of neoplasms in comparison with other endoscopic treatments. Thus, colorectal ESD may become the standard treatment for early colorectal neoplasms in the future. This review article discusses the current research on endoscopic submucosal dissection for colorectal neoplasms.

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Advances in the prevention and treatment of esophageal stricture after endoscopic submucosal dissection of early esophageal cancer

Journal of Translational Internal Medicine ◽

10.2478/jtim-2020-0022 ◽

2020 ◽

Vol 8 (3) ◽

pp. 135-145

Author(s):

Yue Zhang ◽

Baozhen Zhang ◽

Yidan Wang ◽

Jingjing Zhang ◽

Yufan Wu ◽

...

Keyword(s):

Esophageal Cancer ◽

Endoscopic Submucosal Dissection ◽

Esophageal Stricture ◽

Standard Treatment ◽

Early Esophageal Cancer ◽

Submucosal Dissection ◽

Treatment And Prevention ◽

Global Issue ◽

Esophageal Strictures ◽

Standard Treatment Regimen

AbstractEndoscopic submucosal dissection (ESD) has become the main treatment for early esophageal cancer. While treating the disease, ESD may also cause postoperative esophageal stricture, which is a global issue that needs resolution. Various methods have been applied to resolve the problem, such as mechanical dilatation, glucocorticoids, anti-scarring drugs, and regenerative medicine; however, no standard treatment regimen exists. This article describes and evaluates the strengths and limitations of new and promising potential strategies for the treatment and prevention of esophageal strictures.

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Using Endoscopic Submucosal Dissection as a Routine Component of the Standard Treatment Strategy for Large and Complex Colorectal Lesions in a Western Tertiary Referral Unit

Diseases of the Colon & Rectum ◽

10.1097/dcr.0000000000001081 ◽

2018 ◽

Vol 61 (6) ◽

pp. 743-750 ◽

Cited By ~ 9

Author(s):

Andrew Emmanuel ◽

Shraddha Gulati ◽

Margaret Burt ◽

Bu’Hussain Hayee ◽

Amyn Haji

Keyword(s):

Endoscopic Submucosal Dissection ◽

Treatment Strategy ◽

Standard Treatment ◽

Tertiary Referral ◽

Submucosal Dissection

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Palisade technique as an effective endoscopic submucosal dissection tool for large colorectal tumors

Endoscopy International Open ◽

10.1055/a-1313-7026 ◽

2021 ◽

Vol 09 (02) ◽

pp. E210-E215

Author(s):

Yuichiro Suzuki ◽

Ken Ohata ◽

Eiji Sakai ◽

Ryoju Negishi ◽

Maiko Takita ◽

...

Keyword(s):

Local Recurrence ◽

Endoscopic Submucosal Dissection ◽

Standard Treatment ◽

R0 Resection ◽

Colorectal Tumors ◽

Resection Rate ◽

En Bloc ◽

Submucosal Dissection ◽

Safe Technique ◽

Observation Period

Abstract Background and study aims Endoscopic submucosal dissection (ESD) has become the standard treatment for colorectal ESD, but large colorectal tumors remain difficult to remove. We developed a new method, called the palisade technique, by modifying the multiple tunneling technique. In this method, a palisade of submucosal tissue is left beneath the tumor to anchor a dissected specimen, maintaining effective submucosal traction. Patients and methods The study included 11 patients with large colorectal tumors that were over half the circumference of the colorectal lumen which were treated using the palisade technique from August 2017 to October 2019. Overall resection outcomes were assessed. Results All 11 lesions were removed en bloc. The R0 resection rate was 45.6 % because of marginal burning of the specimen, but no local recurrence was found after a median observation period of 31 months. The median submucosal dissection time (SDT) and submucosal dissection speed (SDS) were 170 minutes and 23.1 mm2/min, respectively. One case of post-ESD hemorrhage was successfully managed endoscopically, and two cases of post-colorectal ESD coagulation syndrome were managed conservatively. Conclusion The palisade technique can be an effective and safe technique for treating large colorectal tumors that extend over half the luminal circumference.

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