Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection

Abstract

Suitable lesions for endoscopic treatment include not only early colorectal carcinomas but also several types of precarcinomatous adenomas. It is important to establish practical guidelines wherein preoperative diagnosis of colorectal neoplasia and selection of endoscopic treatment procedures are appropriately outlined and to ensure that actual endoscopic treatment is useful and safe in general hospitals when carried out in accordance with guidelines. In cooperation with the Japanese Society for Cancer of the Colon and Rectum, the Japanese Society of Coloproctology, and the Japanese Society of Gastroenterology, the Japan Gastroenterological Endoscopy Society compiled colorectal endoscopic submucosal dissection/endoscopic mucosal resection guidelines by using evidence‐based methods in 2014. The first edition of these guidelines was published 5 years ago. Accordingly, we have published the second edition of these guidelines based on recent new knowledge and evidence.

Wide-field endoscopic mucosal resection versus endoscopic submucosal dissection for laterally spreading colorectal lesions: a cost-effectiveness analysis

“…Criteria for performing colorectal ESD are broader in most Eastern centres 22. This may not be justified given SMIC has been reported in only 15% of higher risk non-granular lesions and in just 3% of granular LSLs 4.…”

“…Scenario analyses were also performed. This included S-ESD in accordance with the 2015 Japanese Gastroenterological Endoscopy Society Guidelines for colorectal ESD,22 where lesions with pit pattern V, Paris c component or any lesion containing non-granular morphology were treated by ESD. We also evaluated the impact of much higher risks of lesion recurrence and need for surgery with WF-EMR and ESD.…”

Outcomes of ulcerative colitis‐associated dysplasia patients referred for potential endoscopic submucosal dissection

“…However, in cases of non‐polypoid dysplasia, dysplasia with submucosal fibrosis, or large (≥ 20 mm) dysplasia, endoscopic mucosal resection may result in a piecemeal resection. Meanwhile, endoscopic submucosal dissection (ESD) is now widely used in Korea and Japan, mainly to resect large, flat, sporadic colorectal epithelial neoplasms, such as adenomas and early cancers. Experts have recommended ESD as one of the therapeutic options for ulcerative colitis (UC)‐associated dysplasia .…”

Endoscopic Mucosal Dissection

“…Bleeding is the most common complication and occurs in up to 7% of colorectal ESD procedures [16]. Bleeding that occurs during the procedure (immediate bleeding) occurs in up to 7% of cases and is rarely serious.…”

“…Colonic perforation occurs in up to 5-10% of ESD procedures [16]. Full-thickness perforation during the procedure (intra-procedural) usually occurs following deep resection and is immediately appreciated and treated.…”