Abstract
The safety and standardization of endoscopic submucosal dissection (ESD) for colorectal tumors have not yet been established. However, this procedure is steadily being developed, because of its technical difficulties and the unsuitable anatomical characteristics of the colon and rectum. We mainly use a Dual knife for mucosal incision and submucosal dissection. A hook knife or an SB knife Jr. offers an advantage when approaching the intestinal wall from the front or existing severe fibrosis in the submucosal layer. Skillful colonoscopic control, selection of the scope, a distal attachment tip hood, an adequate high-frequency generator and the correct approach strategy should all be considered for the safe performance of ESD. However, the incidence of indicative lesions is rare, because the majority of colorectal tumors are adenomatous large laterally spreading tumors, which can be cured by intentional endoscopic piecemeal resection.
