LIVE INTERACTIVE SURGERY: Endoscopic Submucosal Dissection (ESD) for colonic polyp
Epublication WebSurg.com, Feb 2016;16(02). URL: http://websurg.com/doi/vd01en4676
Colorectal polyps are the most common type of polyps. Early resection before the polyp undergoes malignant transformation is key to long-term survival and to a favorable prognosis. Endoscopic submucosal dissection (ESD) has been developed based on endoscopic mucosal resection (EMR) techniques. ESD can be used to resect lesions regardless of size, location, and fibrosis. Indications for ESD: - colorectal tumors when EMR is not feasible; - tumors >20mm in size; - lateral spreading tumors (non-granular) type; - lateral spreading tumors (granular type) with a nodule; - residual and recurrent tumors. Technique: - to accurately define the margins; - to mark the borders; - to perform a circumferential incision; - to perform a submucosal dissection. Complications: - perforations – 2.4% in colonic ESD; - bleeding – may be immediate or delayed, occurring after the procedure. The overall rate of complications is 1.5%. Endoscopic ultrasound (EUS): The use of high-frequency EUS is useful to determine the depth of invasion of colorectal lesions. According to some studies, the efficacy of EUS is found to be superior to chromoendoscopy in determining the depth of the tumor.