ASGE Postgraduate Course at ACG: Innovative Practices for the Endoscopist of Today, Tomorrow and Beyond | October 2023-10A_Mendoza Ladd

10A_Mendoza Ladd_ESD in the Colon

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This document discusses the use of endoscopic submucosal dissection (ESD) in the colon. The author provides information on the advantages and disadvantages of ESD and the factors to consider when making a decision on whether to use this technique. Optical diagnosis, including evaluating the morphology, classification systems, and using high-definition imaging, can help determine if a lesion is benign or malignant and the depth of invasion. The document also discusses the use of imaging techniques such as endoscopic ultrasound, CT, and MRI in determining the extent of the disease. <br /><br />The author highlights the success rates of ESD, including en bloc resection, R0 resection, and curative resection. They discuss the higher incidence of adverse events, length of stay, and costs associated with surgical resection compared to ESD. The document provides recommendations for the indications of ESD, including large depressed lesions, pseudodepressed LST-NG lesions, lesions with submucosal fibrosis, and residual early carcinoma after endoscopic resection. The guidelines also mention the difficulties in performing en bloc resection with snare EMR.<br /><br />The document emphasizes the need for a multidisciplinary team to perform ESD, including surgeons, radiologists, pathologists, and oncologists. Pathological criteria for cure are discussed, including well-differentiated tumors, negative margins, and the absence of lymphovascular and perineural invasion. New evidence suggests that deep submucosal invasion may not be a significant predictor of lymph node metastasis compared to other factors such as poor differentiation and high-grade tumor budding.<br /><br />The document concludes by recommending surveillance intervals after ESD and emphasizes the importance of understanding the implications and limitations of ESD before starting the procedure. It highlights the importance of recognizing which lesions require ESD and when to proceed with the technique.

Keywords

endoscopic submucosal dissection

colon

optical diagnosis

en bloc resection

curative resection

surgical resection

indications

multidisciplinary team

pathological criteria

surveillance intervals