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Yoshizaki et al. Mini-invasive Surg 2022;6:17 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.116

Review Open Access

Tips for difficult colorectal endoscopic submucosal

dissection

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1,2
1
1
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Tetsuya Yoshizaki , Takashi Toyonaga , Nobuaki Ikezawa , Yoshiko Nakano , Shinwa Tanaka , Tsukasa
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5
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Ishida , David Ozzie Rahni , Harold Jacob , Gabriel Rahmi , Yuzo Kodama 1
1
Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017,
Japan.
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Department of Endoscopy, Kobe University Hospital, Kobe 650-0017, Japan.
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Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan.
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Department of Gastroenterology, Akashi Medical Center, Akashi 674-0063, Japan.
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Department of Gastroenterology, Rhode Island Hospital, Providence, RI 02903, USA.
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Department of Gastroenterology, Hadassah University Medical Center, Jerusalem 91120, Israel.
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Department of Hepatogastroenterology and Endoscopy, Georges Pompidou European Hospital, Paris 75015, France.
Correspondence to: Dr. Takashi Toyonaga, Department of Endoscopy, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku,
Kobe, Hyogo 650-0017, Japan. E-mail: toyonaga@med.kobe-u.ac.jp
How to cite this article: Yoshizaki T, Toyonaga T, Ikezawa N, Nakano Y, Tanaka S, Ishida T, Rahni DO, Jacob H, Rahmi G,
Kodama Y. Tips for difficult colorectal endoscopic submucosal dissection. Mini-invasive Surg 2022;6:17.
https://dx.doi.org/10.20517/2574-1225.2021.116
Received: 16 Oct 2021 First Decision: 12 Jan 2022 Revised: 26 Jan 2022 Accepted: 9 Feb 2022 Published: 22 Mar 2022
Academic Editor: Giulio Belli Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen
Abstract
Colorectal endoscopic submucosal dissection (ESD) is now widely performed and firmly established in the
treatment of early-stage colorectal cancer. In particular, there have been many studies on difficult cases of
colorectal ESD. Difficult cases can be divided into two groups: difficult dissection of the lesions and difficult
approach to the lesion. In most cases, a combination of strategies can solve the problem. Challenging lesions such
as those in the anal canal and ileum can also be treated from an anatomical perspective. In the rectum, there are no
limits to size or circumference. In addition, the indications for ESD in patients without risk of metastasis other than
deep invasion are being considered. Therefore, when ESD is performed on difficult lesions, it is necessary to ensure
the quality of dissection.

Keywords: Endoscopic submucosal dissection, difficult cases, anal canal, ileocecal, muscle retracting sign, fibrosis

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
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