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Background <p>Colorectal neoplasms require adequate diagnosis and therapy.</p> Objective <p>Indication for endoscopic submucosal dissection (ESD) in early colorectal neoplasms and comparison with other resection methods.</p> Materials and methods <p>Literature review and discussion of current national and international treatment guidelines, highlighting the advantages of ESD in early colorectal cancer.</p> Results <p>Early colorectal neoplasms require precise diagnosis before resection. High-resolution endoscopy including digital chromoendoscopy is central. Neoplasms must be classified according to the Paris, laterally spreading tumor, and Japan narrow band imaging expert team (JNET) classifications. Indications for ESD are flat polyps over 2 cm in diameter with nongranular or mixed granular surface structure, and irregular microsurface or vascular pattern (JNET&#xa0;2B). For these lesions, ESD is preferable to other resection techniques. Cancer diagnosis is usually established through histological examination of the resected specimen. If a&#xa0;low-risk situation for lymph node metastases exists (grading 1/2, lymphovascular invasion&#xa0;0, vascular invasion&#xa0;0, tumor budding&#xa0;1, residual tumor&#xa0;0, submucosal invasion &lt; 1000 µm), no further therapy is required. New methods such as endoscopic intermuscular dissection (EID) or artificial intelligence (AI) algorithms could improve pretherapeutic diagnosis, facilitate the ESD procedure, and expand indications for endoscopic en&#xa0;bloc resection.</p>

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Therapie kolorektaler Frühkarzinome – pro endoskopische Submukosadissektion

  • 期刊论文

  • 发表日期：

    2025年9月22日

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  • Markus W. Scheppach,
  • Andreas Probst,
  • Helmut Messmann

摘要

Background

Colorectal neoplasms require adequate diagnosis and therapy.

Objective

Indication for endoscopic submucosal dissection (ESD) in early colorectal neoplasms and comparison with other resection methods.

Materials and methods

Literature review and discussion of current national and international treatment guidelines, highlighting the advantages of ESD in early colorectal cancer.

Results

Early colorectal neoplasms require precise diagnosis before resection. High-resolution endoscopy including digital chromoendoscopy is central. Neoplasms must be classified according to the Paris, laterally spreading tumor, and Japan narrow band imaging expert team (JNET) classifications. Indications for ESD are flat polyps over 2 cm in diameter with nongranular or mixed granular surface structure, and irregular microsurface or vascular pattern (JNET 2B). For these lesions, ESD is preferable to other resection techniques. Cancer diagnosis is usually established through histological examination of the resected specimen. If a low-risk situation for lymph node metastases exists (grading 1/2, lymphovascular invasion 0, vascular invasion 0, tumor budding 1, residual tumor 0, submucosal invasion < 1000 µm), no further therapy is required. New methods such as endoscopic intermuscular dissection (EID) or artificial intelligence (AI) algorithms could improve pretherapeutic diagnosis, facilitate the ESD procedure, and expand indications for endoscopic en bloc resection.