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      Endoscopic Submucosal Dissection (ESD) in Colorectal Tumors

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          Endoscopic submucosal dissection (ESD) – initially developed for the treatment of early gastric cancer in Japan – is an attractive option for en bloc resection of larger sessile or flat colorectal neoplasia.


          A review of the current literature on colorectal ESD was carried out.


          In contrast to conventional endoscopic mucosal resection (EMR), ESD for larger colorectal neoplasia yields high en bloc resection rates and very low recurrence rates. The frequency of delayed bleeding is similar for EMR and ESD. Higher perforation rates during ESD are mostly due to microperforations identified and treated during the intervention, and are therefore of minor clinical relevance. A major disadvantage of ESD is the necessity for high-level endoscopic skills and long procedure times. ESD also has the potential to replace laparoscopic surgery or transanal endoscopic microsurgery mainly due to its lower complication rates.


          ESD for the resection of larger flat or sessile colorectal lesions has potential advantages over conventional EMR or minimally invasive surgery. Due to the low incidence of early gastric cancer, experience with ESD will remain limited in Western countries. The spread of colorectal ESD will depend on adequate training opportunities and also on modifications yielding a reduction in procedure time.



          Die endoskopische Submukosadissektion (ESD) wurde zur Therapie des Magenfrühkarzinoms in Japan entwickelt. Sie ist auch eine attraktive Methode zur En-bloc-Resektion größerer sessiler oder flacher kolorektaler Adenome.


          In dieser Übersicht wurde die Literatur zur kolorektalen ESD gesichtet und bewertet.


          Im Gegensatz zur konventionellen endoskopischen Mukosaresektion (EMR) ermöglicht die ESD eine deutlich höhere En-bloc-Resektionsrate und weist eine geringere Rezidivrate auf. Die Anzahl der Blutungskomplikationen unterscheidet sich nicht. Die höhere Perforationsrate ist von geringer klinischer Bedeutung, da es sich meist um Mikroperforationen handelt, die bei der ESD erkannt und therapiert werden. Der wesentliche Nachteil der ESD besteht in der deutlich längeren Interventionszeit. Gegenüber minimalinvasiven chirurgischen Therapieformen weist die ESD den Vorteil der geringeren Komplikationsrate auf.


          Die kolorektale ESD hat Vorteile gegenüber der konventionellen EMR und auch gegenüber der minimalinvasiven Chirurgie. Aufgrund der geringen Inzidenz des Magenfrühkarzinoms wird die Erfahrung mit ESD in den westlichen Ländern begrenzt bleiben. Die Verbreitung der kolorektalen ESD wird hierzulande wesentlich von den Trainingsmöglichkeiten und auch von technischen Vereinfachungen abhängen, die eine Reduktion des Zeitbedarfs ermöglichen.

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          Most cited references 72

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          Estimates of the cancer incidence and mortality in Europe in 2006.

          Monitoring the evolution of the cancer burden in Europe is of great value. Estimates of the cancer burden in Europe have been published for 2004 and estimates are now being presented for cancer incidence and mortality in Europe for 2006. The most recent sources of cancer incidence and mortality data have been collected and projections have been carried out using short-term prediction methods to produce estimated rates for 2006. Additional estimation was required where national incidence data were not available, and the method involved the projection of the aggregations of cancer incidence and mortality data from representative cancer registries. The estimated 2006 rates were applied to the corresponding estimated country population to obtain the best estimates of the cancer incidence and mortality in Europe in 2006. In 2006 in Europe, there were an estimated 3,191,600 cancer cases diagnosed (excluding nonmelanoma skin cancers) and 1,703,000 deaths from cancer. The most common form of cancers was breast cancer (429,900 cases, 13.5% of all cancer cases), followed by colorectal cancers (412,900, 12.9%) and lung cancer (386,300, 12.1%). Lung cancer, with an estimated 334,800 deaths (19.7% of total), was the most common cause of death from cancer, followed by colorectal (207,400 deaths), breast (131,900) and stomach (118,200) cancers. The total number of new cases of cancer in Europe appears to have increased by 300,000 since 2004. With an estimated 3.2 million new cases (53% occurring in men, 47% in women) and 1.7 million deaths (56% in men, 44% in women) each year, cancer remains an important public health problem in Europe and the ageing of the European population will cause these numbers to continue to increase even if age-specific rates remain constant. Evidence-based public health measures exist to reduce the mortality of breast and colorectal cancer while the incidence of lung cancer, and several other forms of cancer, could be diminished by improved tobacco control.
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            The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002.

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              A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video).

              Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for early gastric cancer, although it is not widely used in the colorectum because of technical difficulty. To examine the current status of colorectal ESDs at specialized endoscopic treatment centers. Multicenter cohort study using a prospectively completed database at 10 specialized institutions. From June 1998 to February 2008, 1111 colorectal tumors in 1090 patients were treated by ESD. Tumor size, macroscopic type, histology, procedure time, en bloc and curative resection rates and complications. Included in the 1111 tumors were 356 tubular adenomas, 519 intramucosal cancers, 112 superficial submucosal (SM) cancers, 101 SM deep cancers, 18 carcinoid tumors, 1 mucosa-associated lymphoid tissue lymphoma, and 4 serrated lesions. Macroscopic types included 956 laterally spreading tumors, 30 depressed, 62 protruded, 44 recurrent, and 19 SM tumors. The en bloc and curative resection rates were 88% and 89%, respectively. The mean procedure time ± standard deviation was 116 ± 88 minutes with a mean tumor size of 35 ± 18 mm. Perforations occurred in 54 cases (4.9%) with 4 cases of delayed perforation (0.4%) and 17 cases of postoperative bleeding (1.5%). Two immediate perforations with ineffective endoscopic clipping and 3 delayed perforations required emergency surgery. Tumor size of 50 mm or larger was an independent risk factor for complications, whereas a large number of ESDs performed at an institution decreased the risk of complications. No long-term outcome data. ESD performed by experienced endoscopists is an effective alternative treatment to surgery, providing high en bloc and curative resection rates for large superficial colorectal tumors. Copyright © 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

                Author and article information

                aDepartment of Medicine and Gastroenterology, Bonn, Germany
                bDepartment of General and Abdominal Surgery, Gemeinschaftskrankenhaus Bonn, Bonn, Germany
                cInstitute for Pathology Bonn-Duisdorf, Bonn, Germany
                Author notes
                *Prof. Dr. Franz Ludwig Dumoulin, Abteilung für Innere Medizin, Gemeinschaftskrankenhaus Bonn, Bonner Talweg 4-6, 53113 Bonn, Germany, f.dumoulin@
                S. Karger Verlag für Medizin und Naturwissenschaften GmbH (Wilhelmstrasse 20A, P.O. Box · Postfach · Case postale, D-79095, Freiburg, Germany · Deutschland · Allemagne, Phone: +49 761 45 20 70, Fax: +49 761 4 52 07 14, )
                February 2014
                3 February 2014
                1 February 2015
                : 30
                : 1
                : 39-44
                Copyright © 2014 by S. Karger GmbH, Freiburg
                Figures: 2, Tables: 1, References: 77, Pages: 6
                Review Article · Übersichtsarbeit


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