Surgical Endoscopy

, Volume 27, Issue 9, pp 3262–3270 | Cite as

Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan

  • Takeshi NakajimaEmail author
  • Yutaka Saito
  • Shinji Tanaka
  • Hiroyasu Iishi
  • Shin-ei Kudo
  • Hiroaki Ikematsu
  • Masahiro Igarashi
  • Yuusuke Saitoh
  • Yuji Inoue
  • Kiyonori Kobayashi
  • Takashi Hisasbe
  • Takahisa Matsuda
  • Hideki Ishikawa
  • Ken-ichi Sugihara



Conventional endoscopic resection (CER) for early colorectal neoplasia (CRN) is widely accepted as a minimally invasive treatment. Endoscopic submucosal dissection (ESD) was developed in Japan to resect larger lesions, but ESD was not covered by the Japanese national health insurance until April 2012. In addition, treatment strategies vary considerably among medical facilities. To evaluate the current situation in Japan regarding endoscopic treatment of CRNs measuring ≥20 mm, we conducted a prospective multicenter study at 18 medium-volume and high-volume specialized facilities in cooperation with the Japan Society for Cancer of the Colon and Rectum (JSCCR).


The JSCCR conducted a multicenter, observational study of all patients treated by CER and ESD of CRNs measuring ≥20 mm.


From October 2007 to December 2010, CERs and ESDs were performed on 1,845 CRNs (CERs 1,029; ESDs 816). Lesions diagnosed as protruded, flat, and depressed totaled 541, 1224, and 48, respectively. En bloc resection rates and mean procedure times for CER/ESD were 56.9 %/94.5 % (P < 0.01) and 18 ± 23 min/96 ± 69 min, respectively. The average ESD procedure time was 129 ± 83 min in the ≥40-mm group. As lesion size increased, the CER en bloc resection rate decreased significantly (trend P < 0.01), but the ESD en bloc resection rate remained over 93 %. Perforation and delayed bleeding rates of CER/ESD were 0.8 %/1.6 % (P < 0.05) and 2 %/2.2 % (P = 0.3), respectively.


The en bloc resection rate for ESD was significantly higher than for CER, although complication rates were fairly low. Despite a longer procedure time, safety of colorectal ESD has improved in various facilities in Japan. However, ESD for lesions measuring ≥40 mm must be performed by experienced endoscopists due to the longer procedure time.


Endoscopic mucosal resection Endoscopic submucosal dissection Colorectal cancer Colorectal neoplasia 



This study was performed within the framework of a project undertaken by the Colorectal Endoscopic Resection Standardization Implementation Working Group in Japanese Society for Cancer of the Colon and Rectum Grants.


Takeshi Nakajima, Yutaka Saito, Shinji Tanaka, Hiroyasu Iishi, Shin-ei Kudo, Hiroaki Ikematsu, Masahiro Igarashi, Yuusuke Saitoh, Yuji Inoue, Kiyonori Kobayashi, Takashi Hisasbe, Takahisa Matsuda, Hideki Ishikawa, and Ken-ichi Sugihara have no conflict of interests or financial ties to disclose.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Takeshi Nakajima
    • 1
    Email author
  • Yutaka Saito
    • 1
  • Shinji Tanaka
    • 2
  • Hiroyasu Iishi
    • 3
  • Shin-ei Kudo
    • 4
  • Hiroaki Ikematsu
    • 5
  • Masahiro Igarashi
    • 6
  • Yuusuke Saitoh
    • 7
  • Yuji Inoue
    • 8
  • Kiyonori Kobayashi
    • 9
  • Takashi Hisasbe
    • 10
  • Takahisa Matsuda
    • 1
  • Hideki Ishikawa
    • 11
  • Ken-ichi Sugihara
    • 12
  1. 1.Endoscopy DivisionNational Cancer Center HospitalChuo-ku, TokyoJapan
  2. 2.Department of EndoscopyHiroshima University HospitalHiroshimaJapan
  3. 3.Department of Gastrointestinal OncologyOsaka Medical Center for Cancer and Cardiovascular DiseasesOsakaJapan
  4. 4.Digestive Disease CenterShowa University Northern Yokohama HospitalYokohamaJapan
  5. 5.Department of Gastroenterology & Gastrointestinal OncologyNational Cancer Center Hospital EastKashiwaJapan
  6. 6.Department of EndoscopyCancer Institute Ariake HospitalTokyoJapan
  7. 7.Digestive Disease CenterAsahikawa City HospitalHokkaidoJapan
  8. 8.Institute of GastroenterologyTokyo Women’s Medical UniversityTokyoJapan
  9. 9.Department of GastroenterologyKitasato University East HospitalSagamiharaJapan
  10. 10.Department of GastroenterologyFukuoka University Chikushi HospitalChikushinoJapan
  11. 11.Department of Molecular-Targeting Cancer PreventionGraduate School of Medical Science, Kyoto Prefectural University of MedicineOsakaJapan
  12. 12.Department of Surgical Oncology, Graduate SchoolTokyo Medical and Dental UniversityTokyoJapan

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