Colorectal endoscopic submucosal dissection: Recent technical advances for safe and successful procedures

• 作者: Katsumi Yamamoto Masafumi Naito Shiro Hayashi Tomoki Michida Toshifumi Ito Tsutomu Nishida
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: Endoscopic SUBMUCOSAL DISSECTION Colo- RECTAL tumo
• 年，卷（期）: 2015,（14）
• 页码范围: 1114-1128
• 页数: 15页
• 分类号: R735.34

摘要

Endoscopic submucosal dissection(ESD) is very useful in en bloc resection of large superficial colorectal tumors but is a technically difficult procedure because the colonic wall is thin and endoscopic maneuverability is poor because of colonic flexure and extensibility. A high risk of perforation has been reported in colorectal ESD. To prevent complications such as perforation and unexpected bleeding, it is crucial to ensure good visualization of the submucosal layer by creating a mucosal flap, which is an exfoliated mucosa for inserting the tip of the endoscope under it. The creation of a mucosal flap is often technically difficult; however, various types of equipment, appropriate strategy, and novel procedures including our clip-flap method, appear to facilitate mucosal flap creation, improving the safety and success rate of ESD. Favorable treatment outcomes with colorectal ESD have already been reported in many advanced institutions, and appropriate understanding of techniques and development of training systems are required for world-wide standardization of colorectal ESD. Here, we describe recent technical advances for safe and successful colorectal ESD.