Special ESD Cases Illustrations

Abstract

To reduce the incidence and mortality of colorectal cancer, endoscopic resection is widely used to remove colorectal adenomas and early cancers. Piecemeal endoscopic mucosal resection is often performed for large lesions (>20 mm) with acceptable outcomes. However, this technique is not optimal because there is a recurrence rate of around 15%. Most residual neoplasms can be removed endoscopically during surveillance procedures; however, surgery is occasionally needed for complete removal. Endoscopic submucosal dissection (ESD) was developed to more effectively treat superficial gastrointestinal tumors. ESD allows high rates of en bloc removal of superficial lesions, which contributes to a low recurrence rate and precise histological evaluations both of the metastatic risk and of the completeness of resection. The use of ESD minimizes the need for endoscopic surveillance, repeated interventions for recurrence, overuse of surgery, and redundant expenses. In this chapter, we describe two cases that underwent ESD in order to demonstrate the clinical benefits of ESD and to share technical tips that help make ESD successful.