COLORECTAL ESD OF LARGE PROTRUDING LESIONS: HOW TO USE THE DOUBLE TUNNEL METHOD

Abstract

Colorectal ESD of large protruding lesions requires advanced techniques. The complexity of large protruding lesions increases with tumor size, as well as the possibility of severe fibrosis and the muscle retracting sign. To address these issues, in addition to the basic tunneling technique, a double tunneling method was used for more difficult cases. In this method, tunnels are created on both sides and dissected if severe fibrosis or a muscle retraction area is observed within the tunnel, thereby improving safety and allowing en bloc resection. Among large protruding lesions, particularly those larger than 4 cm in diameter, there is an increased risk of severe fibrosis and a muscle retracting sign, as well as the possibility of deeper tumor invasion. Therefore, it is important to select a treatment strategy based on a comprehensive assessment of the lesion site, patient background, and pre-operative diagnosis.