| Theme | Technological Innovation of Digestive Endoscopy -- Toward the Next Generation of Endoscopic Medicine | |
|---|---|---|
| Title | Development of Colorectal Endoscopic Submucosal Dissection | |
| Publish Date | 2016/09 | |
| Author | Naohisa Yahagi | Cancer Center, Keio University School of Medicine |
| [ Summary ] | Before the endoscopic submucosal dissection (ESD) procedure had been established, circumferential mucosal incision was introduced as a new resection technique used to facilitate snaring. Several devices utilizing different concepts were then developed to ensure the safety of the procedure. As a result of the increase in the size of the target lesions, we started performing submucosal dissection of the surrounding tissue along the incision line to ensure the application of snare wires to the target lesions. Finally, we found that reliable en‒bloc resection was possible by dissecting submucosal tissue without using the snare. No opportunities were available to perform this procedure in the colon; however, we decided to apply this technique to a small LST‒NG‒PD (laterally spreading tumor non‒glanular pseudo‒depressed type) in the sigmoid colon in 1999 because endoscopic mucosal resection could not achieve complete resection, and our technique involving the use of the tip of a thin‒type snare and a hand‒made transparent hood after creating sufficient submucosal fluid cushion seemed relatively safe even for colonic lesions. The lesion was successfully removed using this technique, and we gradually targeted larger lesions. We are convinced of the efficacy of colonic ESD after experiencing uneventful clinical courses and excellent outcomes of the treated cases, even of those with perforation or very large resection (>10 cm in size). ESD has gradually become popular because of the development of specific devices for colonic procedures. The incidence of colorectal tumors is high in Western countries; therefore, colonic ESD will become more popular around the world with further advancement of new devices. |
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