Colorectal endoscopic submucosal dissection up-to-date

Vollständiger Abstract

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Colorectal endoscopic submucosal dissection (ESD) has emerged as a pivotal organ-preserving strategy for the management of superficial colorectal neoplasms. This review summarizes the current evidence on colorectal ESD, highlighting its indications, technical principles, clinical outcomes, limitations, and learning requirements. Careful preoperative lesion characterization using high-definition endoscopy combined with virtual chromoendoscopy and magnification, is essential for estimating invasion depth and selecting the appropriate candidate. Colorectal ESD is especially indicated for lesions requiring en bloc resection to enable precise histopathological assessment. Compared with endoscopic mucosal resection, colorectal ESD provides substantially higher en bloc and complete resection rates with markedly lower local recurrence, thereby overcoming the limitations of piecemeal resection in large lesions. In eligible patients, colorectal ESD offers a minimally invasive alternative to laparoscopic surgery, with favorable efficacy, shorter procedure-related burden, and preservation of bowel anatomy. Nonetheless, colorectal ESD operations requires a high-level of expertise and technical difficulty is mostly influenced by lesion size, submucosal fibrosis, and proximal colonic location. In addition, colorectal ESD demands structured training, appropriate case selection, and progressive experience, with rectal lesions and low-fibrosis tumors representing the most suitable starting point for novice operators. Colorectal ESD represents a cornerstone of modern therapeutic endoscopy, offering oncologic precision, organ preservation, and durable outcomes, and continues to expand its role in the management of early colorectal neoplasia.