Usefulness and feasibility of endoscopic submucosal dissection for colorectal tumor: a nationwide multicenter retrospective study in Korea

Early superficial gastrointestinal cancer is defined as cancer invasion limited to mucosal or submucosal layers. Until recently surgery was the cornerstone treatment for superficial/early gastrointestinal tumors. Diagnosis rate of precursor lesion of colorectal cancer and early stage colorectal cancer have been increasing rapidly because of increased screening gastrointestinal endoscopies in Korea (1). This trend has also resulted in advances in the therapeutic endoscopy, that is less invasive than surgery. More recently, endoscopic submucosal dissection (ESD) is feasible method in treating early gastric cancer (2).This technique enables en bloc resection of larger than 20mm, leading to exact histologic evaluation of the specimen and low recurrence rate (3-5).However, this technique in colorectal area is not widely used because of technical difficulty, a protracted procedure time, and the risk of complications accompanying the procedure such as perforation, bleeding (4). In Korea, colorectal ESD is performed as actively as in Japan. Although there are some single-center studies about feasibility of colorectal ESD came from Japanese experts (4,6-9), nationwide multicenter study for effectiveness and feasibility of colorectal ESD is still limited. The aim of this study is to investigate the usefulness and feasibility of ESD in colorectum performed by various experienced endoscopists from multiple university hospitals in Korea