| Theme | Towards Standardization of ESD Procedures | |
|---|---|---|
| Title | Practice and Principles of Colorectal ESD | |
| Publish Date | 2017/04 | |
| Author | Yoshiko Obara | Department of Endoscopy, Kobe University Hospital / Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University |
| Author | Takashi Toyonaga | Department of Endoscopy, Kobe University Hospital / Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University / Department of Endoscopy, Kishiwada Tokushukai Hospital |
| Author | Tsukasa Ishida | Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University |
| Author | Yoshinori Morita | Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University |
| Author | Eiji Umegaki | Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University |
| Author | Takeshi Azuma | Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University |
| [ Summary ] | Endoscopic submucosal dissection (ESD) enables en bloc resection of lesions regardless of their size, location, and presence of fibrosis. However, it is indicated for local resection for lesions without lymphnode metastasis. Endoscopists should assess detailed histopathological findings such as differential type, depth of invasion, budding, and lympho vascular invasion of the tumor. In addition to the en bloc resection, specimen should include adequately thick submucosa without injury or denaturation by heat. Technically, ESD facilitates trimming of the ramified vascular network at the level of the middle submucosal layer, reaches the avascular stratum just above the muscle layer, and maintains the appropriate depth for dissection. These processes make it possible to treat vascular rich lesions and fibrotic lesions as well. The appropriate level of dissection is important for performing safe and efficient ESD and leads to obtaining high‒quality specimens. |
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