| Theme |
Colorectal endoscopic submucosal dissection |
| Title |
Overview of present endoscopic treatments for colorectal neoplasia, in relation to endoscopic submucosal dissection (ESD) |
| Author |
Shinji Tanaka |
Department of Endoscopy, Hiroshima University Hospital |
| Author |
Shiro Oka |
Department of Endoscopy, Hiroshima University Hospital |
| Author |
Iwao Kaneko |
Department of Gastroenterology, Hiroshima University Hospital |
| Author |
Mayuko Hirata |
Department of Gastroenterology, Hiroshima University Hospital |
| Author |
Ritsuo Mouri |
Department of Gastroenterology, Hiroshima University Hospital |
| Author |
Hiroyuki Kanao |
Department of Gastroenterology, Hiroshima University Hospital |
| Author |
Toru Kawamura |
Department of Endoscopy, Hiroshima University Hospital |
| Author |
Shigeto Yoshida |
Department of Endoscopy, Hiroshima University Hospital |
| Author |
Kazuaki Chayama |
Department of Gastroenterology, Hiroshima University Hospital |
| [ Summary ] |
Endoscopic submucosal dissection (ESD) for colorectal neoplasia is steadily being developed. However, the incidence of indicative lesions is rare. The indications for ESD to treat colorectal neoplasia are as follows : (1) large (over 20 mm in diameter) lesions in which en bloc resection using snare EMR treatment is difficult, i. e. LST of the non-granular type (LST-NG), particularly the pseudodepressed type, lesions with V1-type pit patterns, cancer with submucosal infiltration and large lesions of the elevated type suspected of being cancerous. (2) fibrosis mucosal lesions, caused by prolapse due to biopsy or peristalsis of the lesion. (3) local residual early cancer after endoscopic resection. (4) sporadic localized tumors, caused by chronic inflammation such as ulcerative colitis. At present, however, the safety and ease of ESD procedures have not been established. On the other hand, intentional endoscopic piecemeal mucosal resection (EPMR) is adequate for treatment of large colorectal neoplasia, when there is detailed magnifying observation prior to treatment. Colonoscopists should select an adequate treatment method, such as EPMR, ESD and surgical resection, for large colorectal neoplasia, considering the clinicopathologic characteristics and the endoscopists' individual skills. |