Endoscopic mucosal resection and endoscopic submucosal dissection of epithelial neoplasia of the colon

Abstract

Endoscopic mucosal resection (EMR) with curative intent has evolved into a safe and effective technique and is currently the gold standard for management of large colonic epithelial neoplasms. Piecemeal EMR is associated with a high risk of local recurrence requiring vigilant surveillance and repeat interventions. Endoscopic submucosal dissection (ESD) was introduced in Japan for the management of early gastric cancer, and has recently been described for en bloc resection of colonic lesions greater than 20 mm. En bloc resection allows accurate histological assessment of the depth of invasion, minimizes the risk of local recurrence and helps determine additional therapy. Morphologic classification of lesions prior to resection allows prediction of depth of invasion and risk of nodal metastasis, allowing selection of the appropriate intervention. This review provides an overview of the assessment of epithelial neoplasms of the colon and the application of EMR and ESD techniques in their management.

Keywords::

• colonic epithelial neoplasms
• curative endoscopic resection
• endoscopic morphologic classification of colonic epithelial neoplasms
• endoscopic mucosal resection
• endoscopic submucosal dissection

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Morphological assessment of epithelial neoplasms of the colon allows for prediction of lesions at high risk for submucosal invasion.

• Endoscopic mucosal resection (EMR) is the gold standard for management of large epithelial neoplasms of the colon.

• In expert hands, EMR has a high success rate for complete resection of epithelial neoplasms of the colon. EMR has a high rate of local recurrence, which can be effectively managed with repeat EMR and ablation.

• Endoscopic submucosal dissection (ESD) is a promising, evolving technique for the management of large epithelial neoplasms of the colon with high rates of en bloc resection. However, ESD is technically challenging and associated with a high rate of perforation.

• The role of ESD in the management of epithelial neoplasms of the colon remains to be defined.

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