Indication for Colorectal EMR/ESD from Japanese Guidelines (JGES, JSGE, JSCCR)

Large adenomatous lesions such as LST of the granular type (LST-G) can be completely cured by piecemeal endoscopic mucosal resection (EMR). Endoscopic submucosal dissection (ESD) is applicable to the lesions that have a higher rate of submucosal invasion that requires detailed and precise histopathologic diagnosis by en bloc resection or to those in which fibrosis has developed at the submucosal layer, and the application of EMR is difficult because of non-lifting signs. The lesions indicative for ESD are as follows: (1) large-sized (larger than 20 mm in diameter) lesions in which en bloc resection is difficult using snare EMR, although it is indicative for endoscopic treatment such as LST of the non-granular type (LST-NG), particularly those of the pseudo-depressed type, lesions with Vi-type pit pattern, carcinoma with submucosal infiltration, and large lesion with elevated type suspected to be cancer; (2) mucosal lesions with fibrosis caused by prolapse due to biopsy or peristalsis of the lesions; (3) local residual early cancer after endoscopic resection; and (4) sporadic localized tumors in chronic inflammation such as ulcerative colitis.