title: Colorectal endoscopic submucosal dissection: Recent technical advances for safe and successful procedures.
abstract: Endoscopic submucosal dissection (ESD) is very useful in en bloc resection of large superficial colorectal tumors but is a technically difficult procedure because the colonic wall is thin and endoscopic maneuverability is poor because of colonic flexure and extensibility. A high risk of perforation has been reported in colorectal ESD. To prevent complications such as perforation and unexpected bleeding, it is crucial to ensure good visualization of the submucosal layer by creating a mucosal flap, which is an exfoliated mucosa for inserting the tip of the endoscope under it. The creation of a mucosal flap is often technically difficult; however, various types of equipment, appropriate strategy, and novel procedures including our clip-flap method, appear to facilitate mucosal flap creation, improving the safety and success rate of ESD. Favorable treatment outcomes with colorectal ESD have already been reported in many advanced institutions, and appropriate understanding of techniques and development of training systems are required for world-wide standardization of colorectal ESD. Here, we describe recent technical advances for safe and successful colorectal ESD.
authors.affiliation: Katsumi Yamamoto, Masafumi Naito, Toshifumi Ito, Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital, Osaka 553-0003, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Katsumi Yamamoto, Masafumi Naito, Toshifumi Ito, Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital, Osaka 553-0003, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Michida
authors.affiliation: Katsumi Yamamoto, Masafumi Naito, Toshifumi Ito, Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital, Osaka 553-0003, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nishida
authors.affiliation: Katsumi Yamamoto, Masafumi Naito, Toshifumi Ito, Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital, Osaka 553-0003, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Hayashi
authors.affiliation: Katsumi Yamamoto, Masafumi Naito, Toshifumi Ito, Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital, Osaka 553-0003, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Naito
authors.affiliation: Katsumi Yamamoto, Masafumi Naito, Toshifumi Ito, Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital, Osaka 553-0003, Japan.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Ito
keywords: Clip-flap method; Colorectal tumors; Endoscopic submucosal dissection; Mucosal flap