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Colorectal endoscopic submucosal dissection: a review on patient selection and indications

Journal Volume 86 - 2023
Issue Fasc.1 - Reviews
Author(s) M. Bronswijk 1 2 3, G. Rasschaert 4, Y. Hayashi 5, H. Yamamoto 5
Full article
Full Article
PAGES 36-46
(1) Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
(2) Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
(3) Imelda Clinical GI Research Center, Bonheiden, Belgium
(4) Department of Gastroenterology and Hepatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
(5) Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan

Background: The development of ‘third-space’-endoscopy has paved the way towards en-bloc resection of early gastrointestinal neoplasia. Endoscopic submucosal dissection (ESD) has improved the endoscopic management of colorectal lesions by facilitating R0-resection, improving histological assessment and preventing recurrence.

Methods: The purpose of this review is to provide an evidence-based overview of indications for which ESD should be considered within colorectal endoscopy.

Results: The development of ESD has partially bridged the gap between endoscopy and surgery, but depends heavily on adequate pre-resection visual evaluation, ruling out potential deep submucosal invasion. ESD should be considered for large colorectal polyps (≥20mm) and/or lesions diagnosed as harbouring high-grade dysplasia, in-situ carcinoma or superficial submucosal invasion. Not only has it found its way into our guidelines for the treatment of neuroendocrine neoplasms, ESD also seems a promising alternative for the controlled resection of large pedunculated lesions. ESD can also be applied in more challenging situations, such as in pre-treated lesions, post-surgical context and in patients with IBD, although this requires a high level of skill and expertise.

Conclusions: In this review we have described the different indications for ESD and attempted to define its place within our current endoscopic armamentarium. For both non-expert and expert endoscopists, knowledge about ESD indications, patient selection and therapeutic alternatives, remains crucial in the care for patients with colorectal neoplasia.

Keywords: ESD, EMR, colorectal cancer, pocket-creation method, neuroendocrine tumors, laterally spreading tumors.

© Acta Gastro-Enterologica Belgica.
PMID 36842174