Endoscopic Submucosal Dissection for Early Colon Cancer

Abstract

Endoscopic submucosal dissection (ESD) was first implemented in early gastric cancer allowing for en-bloc resection of the lesions. With the experience came the expertise to introduce ESD for early colon cancer (ECC). ESD demonstrates several advantages in comparison with the endoscopic mucosa resection. It allows accurate histological assessment of the depth of invasion, minimizes the risk of local recurrence and helps in the determination of additional therapy. Indications for ESD are placed only after adequate endoscopic morphological classification of the lesions excluding higher risk of nodal metastases. This chapter provides an overview of the application of ESD techniques in ESD for ECC and provides assessment on its technical aspects and complications. In order to decrease the rate of complications a standard protocol for the ESD should be adopted. The protocol includes recommendations for patient selection, bowel and patient preparation, appropriate equipment (knives, endoscopes, and power devices). The chapter will review the current ESD techniques and oncological results. ESD could have great impact on the treatment of early colon cancer. Its role is already proven in rectal localizations and despite the challenges it should be adopted for the colon. Safe strategy for ESD is the cornerstone in decreasing complications, which includes suitable resection of specialized ESD devices.