Conflicts of interest: None of the authors has a conflict of interest.
Colorectal endoscopic submucosal dissection: Is it suitable in western countries?
Article first published online: 26 FEB 2013
© 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 28, Issue 3, pages 406–414, March 2013
How to Cite
Uraoka, T., Parra-Blanco, A. and Yahagi, N. (2013), Colorectal endoscopic submucosal dissection: Is it suitable in western countries?. Journal of Gastroenterology and Hepatology, 28: 406–414. doi: 10.1111/jgh.12099
Author contributions: Toshio Uraoka—planning, manuscript drafting; Adolfo Parra-Blanco—planning, manuscript drafting; Naohisa Yahagi—manuscript direction.
- Issue published online: 26 FEB 2013
- Article first published online: 26 FEB 2013
- Accepted manuscript online: 27 DEC 2012 05:35AM EST
- Manuscript Accepted: 12 DEC 2012
- colorectal cancer;
- endoscopic submucosal dissection
Endoscopic submucosal dissection (ESD) represents a significant advance in therapeutic endoscopy with the major advantage being the ability to achieve a higher en bloc resection rate for early stage lesions. Western endoscopists infrequently perform colorectal ESD (CR-ESD) because of the greater technical difficulty involved, longer procedure times, and increased risk of perforation. Specialized training and sufficient clinical experience are necessary to successfully perform ESDs, but a systematic education and training program has still not been established in Japan or elsewhere in the world. Experts generally acknowledge that the stomach is the first organ in which endoscopists should begin performing ESDs. The incidence and detection rates for early stage gastric cancer are significantly higher in Japan than in western countries, so Japanese endoscopists have a greater opportunity to perform gastric ESDs than their western counterparts. It is logical to ask, therefore, whether CR-ESD can be effectively applied in western countries. Based on a review of the relevant literature and our practical perspective, we have focused on the progress made in performing CR-ESD, its indications, training methods, and learning curve. Use of animal gastric and colon models is strongly recommended along with accumulating the necessary experience from the rectum to the colon on a step-by-step basis. It is reasonable to assume that an increasing number of CR-ESDs will be performed by western endoscopists in the foreseeable future given the continuing development of new techniques, and the refinement of instruments and other technologically advanced devices together with the creation of even more effective submucosal injection agents.