Background and Aims. Endoscopic submucosal dissection (ESD) is not widely used in large colorectal lesions because of technical difficulty and possible complications. We aimed to examine the efficacy and safety of ESD for large colorectal neoplasms. Patients and Methods. During the past 5 years, 608 cases of colorectal neoplasm (≧20？mm) were treated by ESD. They were divided into Group A (20–49？mm, 511 cases) and Group B (≧50？mm, 97 cases). Results. The average age, lesion size, and procedure time were 67.4 years, 30.0？mm, and 60.0？min in Group A, and they were 67.1 years, 64.2？mm, and 119.6？min in Group B. En bloc resection rates were 99.2% and 99.0% ( ), and complication rates were 4.1% and 9.9% ( ). Complications in Group A consisted of perforation (2.7%), bleeding (1.2%), and ischemic colitis (0.2%). Those in Group B were perforation (8.2%) and bleeding (1.0%). Two cases in Group A and none in Group B required emergency surgery for perforation. Conclusions. There was no difference in efficacy between Groups A and B. Complications were more frequent in Group B, but all perforations in Group B were successfully managed conservatively. ESD can be effective and safe for large colorectal tumors. 1. Introduction More than 20 years have passed since the introduction of endoscopic mucosal resection (EMR) to the treatment of digestive tract tumors, and the endoscopic treatment is now widely performed for early digestive tract cancers including stomach esophageal, and colon cancers [1–4]. More recently, endoscopic submucosal dissection (ESD) has been developed as a new technique [5], and an en bloc endoscopic resection of large lesions and lesions with ulcer scars has become possible [6]. ESD is a minimally invasive treatment and enables the en bloc resection for early colorectal neoplasm. However, it is not widely used in the large neoplastic lesions because of technical difficulty and complications. It has been reported that the tumor size of 50？mm or large is an independent risk factor for complications [7]. We aimed to examine the safety, efficacy and complications of ESD for large colorectal neoplasms (larger than 20？mm) in a nonacademic hospital in Japan, retrospectively. 2. Patients and Methods We have treated 608 cases of colorectal neoplasm (size ≧20？mm) from July 2007 to December 2012. All cases were carried out with 1 expert and/or 5 novice endoscopists who had performed under expert’s supervision. We have treated 608 cases of colorectal neoplasm (size ≧20？mm) from July 2007 to December 2012. We divided the cases into two groups by size: Group A
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