Abstract
Endoscopic treatment for colorectal epithelial neoplasms is classified into two groups as follows: 1.conventional method such as endoscopic submucosal resection (EMR) and polypectomy, 2.endoscopic submucosal dissection (ESD), excellent technique for en bloc resec-tion of large lesions newly developing in recent years. We describe how to cope with bleeding and perforation, main complications of these procedures, focusing on the difference of technique. Previous to every procedure, patients should be informed of the potential risks about possible complications. First of all, adequate colonic preparation and good operative view are indispensable for safe endoscopic treatments. EMR and polypectomy are generally accepted technique. Bleeding, a common complication in these procedures, can be managed by hemostasis using endoclips. In case of EMR for large lesions, careful snaring without involving proper muscle layer is needed for prevention of perforation. ESD is technically difficult with higher risk of perforation, and should be perfor-med only by expert therapeutic endoscopists. Good positioning and maneuverability of the endoscope is essential. Dissection manipulated under frontal view of the thickened submucosal layer is important for successful ESD. Complications may possibly be managed conservatively when coped with appropriate ways.
