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Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection

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Abstract

Endoscopic submucosal dissection (ESD) allows en bloc resection of a lesion, irrespective of the size of the lesion. ESD has been established as a standard method for the endoscopic ablation of malignant tumors in the upper gastrointestinal (GI) tract in Japan. Although the use of ESD for colorectal lesions has been studied via clinical research, ESD is not yet established as a standard therapeutic method for colorectal lesions because colorectal carcinoma has unique pathological, organspecific characteristics that differ radically from those of the esophagus and stomach, and scope handling and control is more difficult in the colorectum than in the upper GI tract. Depending on the efficacy of endoscopic mucosal resection (EMR) and the clinicopathological characteristics of the colorectal tumor, the proposed indications for colorectal ESD are as follows: (1) lesions difficult to remove en bloc with a snare EMR, such as nongranular laterally spreading tumors (particularly the pseudodepressed type), lesions showing a type Vi pit pattern, and large lesions of the protruded type suspected to be carcinoma; (2) lesions with fibrosis due to biopsy or peristasis; (3) sporadic localized lesions in chronic inflammation such as ulcerative colitis; and (4) local residual carcinoma after EMR. Colorectal ESD is currently in the development stage, and a standard protocol will be available in the near future. We hope that colorectal tumors will be efficiently treated by a treatment method appropriately selected from among EMR, ESD, and surgical resection after precise preoperative diagnosis based on techniques such as magnifying colonoscopy.

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References

  1. Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001;48:225–229.

    Article  PubMed  CAS  Google Scholar 

  2. Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 2006;41:929–942.

    Article  PubMed  Google Scholar 

  3. Yahagi N, Fujishiro M, Omata M. Endoscopic submucosal dissection of colorectal lesion. Dig Endosc 2004;16Suppl:S178–S181.

    Article  Google Scholar 

  4. Hotta K, Oyama T, Miyata Y, Tomori A, Takahashi A, Kitamura Y, et al. Techniques for and challenges with endoscopic submucosal dissection methods employing Hook knife for colorectal neoplasms (in Japanese with English abstract). Early Colorectal Cancer 2006;10:501–505.

    Google Scholar 

  5. A special issue “Colorectal endoscopic submucosal resection”. Knack and pitfall of colorectal endoscopic submucosal dissection (ESD) with special reference with the difference between stomach and colorectum (in Japanese with English abstract). Early Colorectal Cancer 2006;10:489–538.

    Google Scholar 

  6. Tanaka S, Oka S, Kaneko I, Hirata M, Mouri R, Kanao H, et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc 2007;66:100–107.

    Article  PubMed  Google Scholar 

  7. Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, et al. Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol 2007;5:678–683.

    Article  PubMed  Google Scholar 

  8. Tamegai Y, Saito Y, Masaki N, Hinohara C, Oshima T, Kogure E, et al. Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy 2007;39:418–422.

    Article  PubMed  CAS  Google Scholar 

  9. Saito Y, Uraoka T, Matsuda T, Emura F, Ikehara H, Mashimo Y, et al. Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc 2007;66:966–973.

    Article  PubMed  Google Scholar 

  10. Yamamoto H. Endoscopic submucosal dissection of early cancers and large flat adenomas. Clin Gastroenterol Hepatol 2005;3Suppl:S74–S76.

    Article  PubMed  Google Scholar 

  11. Yamamoto H, Kawata H, Sunada K, Satoh K, Kaneko Y, Ido K, et al. Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate. Gastrointest Endosc 2002;56:507–512.

    Article  PubMed  Google Scholar 

  12. Yamamoto H, Sekine Y, Higashizawa T, Kihira K, Kaneko Y, Hosoya Y, et al. Successful en bloc resection of a large superficial gastric cancer by using sodium hyaluronate and electrocautery incision forceps. Gastrointest Endosc 2001;54:629–632.

    Article  PubMed  CAS  Google Scholar 

  13. Yamamoto H, Koiwai H, Yube T, Isoda N, Sato Y, Sekine Y, et al. A successful single-step endoscopic resection of a 40 millimeter flat-elevated tumor in the rectum: endoscopic mucosal resection using sodium hyaluronate. Gastrointest Endosc 1999;50:701–704.

    Article  PubMed  CAS  Google Scholar 

  14. Fujishiro M, Yahagi N, Nakamura M, Kakushima N, Kodashima S, Ono S, et al. Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar. Gastrointest Endosc 2006;63:243–249.

    Article  PubMed  Google Scholar 

  15. Kita H, Yamamoto H. New indications of double balloon endoscopy. Gastrointest Endosc 2007;66Suppl:S57–S59.

    Article  PubMed  Google Scholar 

  16. Yamasaki M, Kume K, Yoshikawa I, Otsuki M. A novel method of endoscopic submucosal dissection with blunt abrasion by submucosal injection of sodium carboxymethylcellulose: an animal preliminary study. Gastrointest Endosc 2006;64:958–965.

    Article  PubMed  Google Scholar 

  17. Saito Y, Uraoka T, Matsuda T, Emura F, Ikehara H, Mashimo Y, Kikuchi T, et al. A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation. Gastrointest Endosc 2007;65:537–542.

    Article  PubMed  Google Scholar 

  18. Tanaka S, Oka S, Chayama K. Endoscopic mucosal resection for superficial early colorectal carcinoma—indication, choice of methods and outcome (in Japanese with English abstract). Gastroenterol Endosc 2004;46:243–252.

    Google Scholar 

  19. Tanaka S, Oka S, Chayama K. Knack and pitfalls of magnifying colonoscopic observation for colorectal neoplasia (in Japanese with English abstract). Gastroenterol Endosc 2005;47:1128–1137.

    Google Scholar 

  20. Tanaka S, Oka S, Kanao H, Kawamura T, Kaneko I, Hirata M, et al. Endoscopic treatment of laterally spreading tumor (LST) based on its clinicopathological features-piecemeal EMR vs ESD (in Japanese with English abstract). Stomach Intestine 2005;40:1790–1805.

    Google Scholar 

  21. Tanaka S, Oka S, Kaneko I, Hirata M, Mouri R, Kanao H, et al. Overview of present endoscopic treatments for colorectal neoplasia, in relation to endoscopic submucosal dissection (ESD) (in Japanese with English abstract). Early Colorectal Cancer 2006;10:481–487.

    Google Scholar 

  22. Tanaka S, Oka S, Chayama K. Strategy of endoscopic treatment for colorectal tumor; recent progress and perspective. In: Niwa H, Tajiri H, Nakajima M, Yasuda K, editors. New challenges in gastrointestinal endoscopy. Tokyo: Springer Japan; 2008. p. 353–366.

    Google Scholar 

  23. Kudo S. Endoscopic mucosal resection of flat and depressed early colorectal cancer. Endoscopy 1993;25:455–461.

    PubMed  CAS  Google Scholar 

  24. Tanaka S, Haruma K, Oka S, Takahashi R, Kunihiro M, Kitadai Y, et al. Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm. Gastrointest Endosc 2001;54:62–66.

    Article  PubMed  CAS  Google Scholar 

  25. Hurlstone DP, Atkinson R, Sanders DS, Thomson M, Cross SS, Brown S. Achieving R0 resection in the colorectum using endoscopic submucosal dissection. Br J Surg 2007;941:536–542.

    Google Scholar 

  26. Antillon MR, Bartalos CR, Miller ML, Diaz-Arias AA, Ibdah JA, Marshall JB. En bloc endoscopic submucosal dissection of a 14-cm laterally spreading adenoma of the rectum with involvement to the anal canal: expanding the frontiers of endoscopic surgery (with video). Gastrointest Endosc 2008;67:332–337.

    Article  PubMed  Google Scholar 

  27. Tsuda S. Complications related to endoscopic submucosal dissection (ESD) of colon and rectum and risk management procedures (in Japanese with English abstract). Early Colorectal Cancer 2006;10:539–550.

    Google Scholar 

  28. Tanaka S, Kaltenbach T, Chayama K, Soetikno RM. Highmagnification colonoscopy. Gastrointest Endosc 2006;64:604–613.

    Article  PubMed  Google Scholar 

  29. Walsh RM, Ackroyd FW, Shellito PC. Endoscopic resection of large sessile colorectal polyps. Gastrointest Endosc 1992;38:303–309.

    PubMed  CAS  Google Scholar 

  30. Binmoeller KF, Bohnacker S, Seifert H, Thonke F, Valdeyar H, Soehendra N. Endoscopic snare excision of “giant” colorectal polyps. Gastrointest Endosc 1996;43:183–188.

    Article  PubMed  CAS  Google Scholar 

  31. Inoue Y, Suzuki S, Suzuki M, Murata Y, Iizuka B, Nakamura T, et al. Endoscopic management of submucosal colorectal cancers (in Japanese with English abstract). Gastroenterol Endosc 1998;40:1011–1017.

    Google Scholar 

  32. Yoshikane H, Hidano H, Sakakibara A, Mori S, Takahashi Y, Niwa Y, et al. Endoscopic resection of laterally spreading tumours of the large intestine using a distal attachment (in Japanese with English abstract). Endoscopy 1999;31:426–430.

    Article  PubMed  CAS  Google Scholar 

  33. Kobayashi H, Fuchigami T, Sakai Y, Oda H, Kikuchi Y, Nagamura S, et al. A study of remnant or recurrent colorectal lesions (adenomas, mucosal carcinoma) after endoscopic resection (in Japanese with English abstract). Stomach Intestine 1999;34:597–610.

    Google Scholar 

  34. Ohta T, Saitoh Y, Orii Y, Watari J, Murakami M, Yoshida A, et al. Risk of local recurrence after endoscopic resection of colorectal tumors (in Japanese with English abstract). Stomach Intestine 1999;34:611–618.

    Google Scholar 

  35. Cho E, Mochizuki N, Tanaka K, Uno K, Tsukada K, Ueda M, et al. Local recurrence after endoscopic mucosal resection (EMR) in cases with colorectal large sessile mucosal tumors (in Japanese with English abstract). Stomach Intestine 1999;34:619–628.

    Google Scholar 

  36. Kudo SE, Yamano Y, Imai Y, Nakasato M, Kogure E, Ishikawa K, et al. Local efficacy of resected margin after endoscopic resection—comparison of ordinary endoscopy and magnifying endoscopy (in Japanese with English abstract). Stomach Intestine 1999;34:629–634.

    Google Scholar 

  37. Tamura T, Ando M, Kusaka T, Mishima T, Chonan A, Mochizuki F. Indications, complications, and curability of endoscopic piecemeal mucosal resection (EPMR) for colorectal neoplasms (in Japanese with English abstract). Endosc Dig 2001;13:1581–1593.

    Google Scholar 

  38. Higaki S, Hashimoto S, Harada K, Nohara H, Saito Y, Gondo T, et al. Long-term follow-up of large flat colorectal tumors resected endoscopically. Endoscopy 2003;35:845–849.

    Article  PubMed  CAS  Google Scholar 

  39. Tamura S, Nakajo K, Yokoyama Y, Ohkawauchi K, Yamada T, Higashidani Y, et al. Evaluation of endoscopic mucosal resection for laterally spreading rectal tumors. Endoscopy 2004;36:306–312.

    Article  PubMed  CAS  Google Scholar 

  40. Hurlstone DP, Sanders DS, Cross SS, Adam I, Shorthouse AJ, Brown S, et al. Colonoscopic resection of lateral spreading tumours: a prospective analysis of endoscopic mucosal resection. Gut 2004;53:1334–1339.

    Article  PubMed  CAS  Google Scholar 

  41. Uraoka T, Kato J, Ishikawa S, Harada K, Kuriyama M, Takemoto K, et al. Thin endoscope-assisted endoscopic submucosal dissection for large colorectal tumors (with videos). Gastrointest Endosc 2007;66:836–839.

    Article  PubMed  Google Scholar 

  42. Saito Y, Emura F, Matsuda T, Uraoka T, Nakajima T, Ikematsu H, et al. A new sinker-assisted endoscopic submucosal dissection for colorectal cancer. Gastrointest Endosc 2005;62:297–301.

    Article  PubMed  Google Scholar 

  43. Kanehira E, Raestrup H, Schurr MO, Wehrmann M, Manncke K, Buess GF. Transanal endoscopic microsurgery using a newly designed multifunctional bipolar cutting and monopolar coagulating instrument. Endosc Surg Allied Technol 1993;1:102–106.

    PubMed  CAS  Google Scholar 

  44. Maeda K, Maruta M, Sato H, Hanai T, Masumori K, Matumoto M, et al. Outcomes of novel transanal operation for selected tumors in the rectum. J Am Coll Surg 2004;199:353–360.

    Article  PubMed  Google Scholar 

  45. Hirata M, Tanaka S, Oka S, Kaneko I, Yoshida S, Yoshihara M, et al. Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors. Gastrointest Endosc 2007;65:988–995.

    Article  PubMed  Google Scholar 

  46. Hirata M, Tanaka S, Oka S, Kaneko I, Yoshida S, Yoshihara M, et al. Evaluation of microvessels in colorectal tumors by narrow band imaging magnification. Gastrointest Endosc 2007;66:945–952.

    Article  PubMed  Google Scholar 

  47. Uraoka T, Saito Y, Matsuda T, Ikehara H, Gotoda T, Saito D, et al. Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut 2006;55:1592–1597.

    Article  PubMed  CAS  Google Scholar 

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Tanaka, S., Oka, S. & Chayama, K. Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol 43, 641–651 (2008). https://doi.org/10.1007/s00535-008-2223-4

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  • DOI: https://doi.org/10.1007/s00535-008-2223-4

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