Endoscopic Submucosal Dissection Can Be Safe, Effective for Early Stage Colorectal Cancer

Erkaya M, Ulkucu A, Erozkan K, et al. Is Endoscopic Submucosal Dissection Safe in the Management of Early-stage Colorectal Cancers? Am J Surg. 2024;in press.

Giri B. The Scalpel or the Scope? Balancing Prudence and Practicality for Endoscopic Submucosal Dissection in Early Colorectal Cancer. Am J Surg. 2025; in press.

Erkaya and coauthors used data from institutional databases to identify patients with early stage colorectal cancer (CRC) who were treated with endoscopic submucosal dissection (ESD, n = 24); oncologic colorectal resection (OCR, n = 90); and OCR after ESD (n = 59).

Pathological and outcomes data were compared. The data showed that OCR after ESD had a higher proportion of non-granular lesions with deeper submucosal invasion. At 2 years of follow-up, disease-free survival was similar in all three groups.

The authors emphasized that adherence to guidelines that optimize prediction of lymph node metastasis was an important component of the ESD approach. They concluded that ESD was oncologically safe and had potential value for treatment of early-stage colorectal cancer.

In the editorial that accompanied the article, Giri emphasized that adoption of ESD in the US will likely be limited by the steep learning curve and large number of cases (250–350) needed to achieve proficiency in the procedure.