Mindful choice of endoscopic resection for large colorectal lesions

ESD or not ESD? This question has probably come up in the minds of many advanced endoscopists in the Western world, when debating on how to approach resection of large non-pedunculated colorectal polyps. The benefit of endoscopic submucosal dissection (ESD) is twofold. First, it can achieve en bloc curative resection of low-risk colorectal cancers (CRC)1 that have only invaded the superficial (less than 1000 µm) submucosal layer (sm1 cancers), and that do not show lymphovascular invasion or poor differentiation.2 Second, the recurrence rate following ESD is only 1%–2%.3 But the procedure carries a greater risk of complications, it requires extensive training and special skill, and perhaps more importantly for Western endoscopists, it takes a long time, patience and a different mindset.3 4 The defenders of colorectal endoscopic mucosal resection (EMR) argue that it is safe and efficient and that recurrence can easily...

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