Endoscopic submucosal dissection for colorectal lesions

Endoscopic submucosal dissection (ESD) has been developed to overcome limitations of conventional endoscopic resection techniques. By using ESD, curative treatment can be reliably confirmed by histopathologic examination of the specimen that was resected completely in an en bloc fashion. Data published by Japanese experts suggest that colorectal ESD is both effective and safe when performed by experts. ESD can achieve reliable complete resection even for large and difficult lesions that were entirely impossible to resect by conventional endoscopic mucosal resection technique. However, colorectal ESD is more difficult than gastric and esophageal ESD so that it is necessary to have specific devices and treatment strategy. Because the balance between the risk and benefit is always very important, appropriate training is necessary before starting to perform colorectal ESD.