Description

Background: Endoscopic submucosal dissection (ESD) is recognised as an effective therapeutic modality for the clearance of neoplasms in the gastrointestinal tract, especially for early, mucosal gastric cancer. The technique is now being developed for en-bloc excision of some large colorectal neoplasms but due to the technical complexity and risk of complication, case selection and well planned training is mandatory.

Methods: Three learning phases in the development of a colorectal ESD service were identified. The 1st phase was to understand the basic principles of ESD which consisted of lectures, observation of the procedure and practice on animal models. The 2nd phase was to learn the technique
under the supervision of an expert. In the 3rd phase, ESD
excisions were performed by UK-based endoscopists as the
sole operators.

Results: During the training period, 9 patients with colorectal neoplasm were treated successfully with ESD. Lesions resected were between 20 by 25mm and 65 by
70mm (median 30mm by 30mm) in diameter and included
four lesions where recurrence had occurred after previously
attempted endoscopic snare resection. The mean procedure
time was 127mins (70-300 min). En-bloc resection was
performed on 7/9 patients. The only major complication
was post polypectomy bleeding in one patient 14 days after
the procedure which required a 2 unit blood transfusion but
no surgical intervention.

Conclusion: After appropriate training, ESD can be performed successfully by UK-based endoscopists for the
excision of selected colorectal lesions. Procedures are time-consuming and technically demanding but current experience suggests that with careful planning they can be performed with an acceptable safety profile and good medium term results.