一种简易牵引装置在结肠内镜黏膜下剥离术中的临床应用（含视频）

评估在结肠内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）中,金属夹联合丝线和橡皮圈作为简易内牵引装置的临床应用价值。以2021年1月至2022年7月间,在南通大学附属江阴医院进行ESD治疗的56例早期结肠癌和癌前病变患者为研究对象,采用计算机软件随机分配,分为常规ESD治疗的对照组（n=28）和金属夹联合丝线及橡皮圈牵引的牵引组（n=28）。对两组患者的ESD手术总时间、黏膜剥离时间、黏膜下注射次数、完整切除病灶率、手术并发症等情况进行综合比较。结果牵引组手术总时间较对照组短［（74.64±33.25）min比（117.18±35.75）min,t=4.61,P<0.001］;牵引组黏膜剥离时间较对照组短［（51.61±24.87）min比（99.11±32.73）min,t=6.11,P<0.001］;牵引组黏膜下注射次数较对照组少［（1.68±1.16）次比（4.96±1.41）次,t=9.57,P<0.001］;两组患者在手术面积和完整切除率及手术并发症方面差异无统计学意义（P>0.05）。可见,金属夹联合丝线及橡皮圈的作为牵引辅助装置,可以降低结肠ESD的技术难度,缩短手术时间。     

不同直径结直肠早癌及癌前病变行内镜黏膜下剥离术的对比分析

目的 探讨分析内镜黏膜下剥离术(ESD)治疗不同直径结直肠肿瘤的差异性。 方法 收集2012年10月至2015年12月中国人民解放军总医院第七医学中心消化内镜中心210处结直肠ESD治疗的临床资料进行回顾性分析,将病灶按直径分为两组(直径≥4.0cm组和直径<4.0cm组),进行相关因素的对比分析。结果 210处结直肠ESD平均手术时间为（50.3±42.7）分钟,病灶平均大小为（7.98 ±10.84cm₂）;整块切除率91.4%,完整切除率90.5%,治愈性切除率88.6%。穿孔发生率5.2%,迟发性出血率0.5%。与直径< 4.0 cm 的肿瘤相比,切除直径≥ 4.0 cm 的肿瘤所需时间更长(79.63±53.91 min比35.28±24.99 min;P<0.001);病变主要位于直肠(61.97%);LST息肉以结节混合型为主(54.93%);整块切除率、完整切除率和治愈性切除率均低于切除直径< 4.0 cm 的肿瘤,其中完整切除率差异有统计学意义(85.92% vs. 94.24%; P=0.041)。直径≥4.0cm组穿孔率增高(7.04%),但两组穿孔率的差异没有统计学意义。结论 ESD切除直径≥ 4.0 cm的结直肠肿瘤,所需时间明显增加,手术风险更高。对于非直肠的病变要更加小心处理。     

内镜下黏膜剥离术治疗直径≥20 mm结直肠侧向发育肿瘤并发出血及穿孔的危险因素分析

目的 探讨内镜下黏膜剥离术(ESD)治疗直径≥20 mm的结直肠侧向发育肿瘤(LST)并发出血、穿孔的影响因素。方法 纳入2016年1月～2019年12月病变直径≥20 mm且行ESD治疗的结直肠LST患者172例,根据术后是否并发出血或穿孔,将172例患者分别分为出血组(9例)和非出血组(163例)、穿孔组(14例)和非穿孔组(158例)。对入组患者并发出血、穿孔的危险因素进行分析。结果 出血发生率为5.23%,穿孔发生率为8.14%,手术时间≥120 min是ESD治疗直径≥20 mm结直肠LST并发出血的独立危险因素(OR=0.205,95%CI 0.051～0.822,P=0.025),高龄(OR=0.945,95%CI 0.897～0.996,P=0.035)及病灶纤维化(OR=0.105,95%CI 0.027～0.405,P=0.001)是ESD治疗直径≥20 mm结直肠LST发生穿孔的独立危险因素。结论 在ESD治疗直径≥20 mm的结直肠LST过程中,手术时间≥120 min为术后并发出血的危险因素,高龄及病灶纤维化会增加穿孔发生的可能。     

橡皮圈腔内牵拉法在内镜黏膜下剥离术中辅助价值研究

目的　评价橡皮圈腔内牵拉法用于内镜黏膜下剥离术（endoscopic submucosal dissection,ESD） 中的有效性及安全性。方法　纳入2016年1月—2019年12月因直肠内分泌瘤就诊于首都医科大学附属北京友谊医院的49例患者,其中2016年1月—2018年5月行常规ESD的患者32例（非牵拉组）,2018年6月—2019年12月行橡皮圈腔内牵拉ESD的患者17例（牵拉组）,比较2组患者基本信息、ESD手术时间、并发症等指标。结果　牵拉组和非牵拉组在年龄、性别及病变大小方面差异均无统计学意义（P均>0.05）。牵拉组ESD操作时间为（13.76±5.71） min,非牵拉组ESD操作时间为（22.99±10.32） min,两者差异有统计学意义（t=-3.408,P=0.001）。牵拉组未发生术后并发症,非牵拉组有3例出现穿孔,但穿孔发生率差异无统计学意义（P=0.542）。结论　橡皮圈腔内牵拉法辅助ESD,可以安全完成ESD操作并有效提高剥离效率。     

结直肠侧向发育型肿瘤内镜黏膜下剥离术手术时长的影响因素

目的探讨内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）治疗结直肠侧向发育型肿瘤（laterally spreading tumor,LST）手术时长的影响因素。方法回顾性纳入于2013年6月—2019年3月在北京市消化疾病中心行ESD治疗的结直肠LST患者。对ESD手术时间延长（≥60 min）的影响因素先进行单因素分析,对于其中有统计学差异的因素再纳入多因素Logistic回归分析独立危险因素。结果纳入了201位患者,年龄(65.05±10.44)岁,其中男性占53.73%。患者有病变213处,病变长径(2.52±1.67)cm。病变整块切除率、完整切除率和治愈性切除率分别为93.90%、84.04%和79.81%。术中穿孔率、迟发穿孔率和迟发出血率分别为1.88%、0.94%和1.41%。单因素分析显示,病变直径≥3 cm（OR=13.48,P<0.001）、结节混合型（OR=25.28,P=0.002）、颗粒均一型（OR=9.00,P=0.045）、位于直乙部位（OR=3.08,P=0.002）以及抬举征阴性（OR=3.40,P=0.012）与ESD手术时间延长相关。多因素Logistic回归分析表明,直径≥3 cm（OR=9.29,P<0.001）、结节混合型（OR=8.80,P=0.043）和抬举征阴性（OR=3.43,P=0.043）是手术时间延长的独立危险因素。ESD手术时间延长,病变的完整切除率（69.56%比88.55%,P=0.003）和治愈性切除率（63.64%比85.50%,P=0.002）显著降低,发生癌变的风险显著升高（86.96%比51.91%,P<0.001）。结论当LST直径≥3 cm、结节混合型或抬举征阴性时,ESD的手术时间延长。手术时间越长,ESD的切除效率越低,病变发生癌变的风险越高。     

橡皮圈组织夹内牵引辅助在内镜黏膜下 剥离术治疗结直肠病变中的应用（含视频）

目的评价橡皮圈组织夹内牵引辅助内镜黏膜下剥离术（rubber band and clip facilitated endoscopic submucosal dissection, RAC ESD）治疗结直肠病变的安全性和有效性。方法采用回顾性队列研究方法,分析2018年9月—2019年8月间在北京大学第一医院内镜中心接受内镜黏膜下剥离术（endoscopic submucosal dissection,ESD)治疗,符合纳入和排除标准的115例结直肠病变患者,依照ESD手术方式分为RAC ESD组（n=34）及传统ESD组（n=81）,比较两组间手术时间、单位时间切除面积、整块切除率、完全切除率、治愈性切除率、并发症发生率及肿瘤复发率等指标。结果RAC ESD组中位标本面积632(753) cm2,中位手术时间400(550) min,中位单位时间切除面积014(020) cm2/min。传统ESD组中位标本面积471(502) cm2,中位手术时间500(500) min,中位单位时间切除面积009(007) cm2/min。RAC ESD组标本面积略大于传统ESD组,手术时间略短于传统ESD组,但差异均无统计学意义（P均＞005）。RAC ESD组单位时间切除面积明显大于传统ESD组（P=0008）。RAC ESD组整块切除率、完全切除率及治愈性切除率分别为1000%（34/34）、1000%（34/34）及971%（33/34）,传统ESD组分别为1000%（81/81）、963%（78/81）和914%（74/81）。两组均无操作相关并发症发生。经过（100±55）个月随访,两组均无局部复发。结论RAC ESD治疗结直肠病变可提高手术效率,安全有效。     

钛夹联合尼龙绳牵引辅助技术在内镜黏膜下剥离术治疗早期胃角癌中的临床研究

目的 评估钛夹联合尼龙绳牵引辅助下内镜黏膜下剥离术（ESD）治疗早期胃角癌及癌前病变的应用价值及安全性。方法 以2018年1—12月在杭州市第一人民医院行ESD治疗的59例早期胃角癌及癌前病变患者为研究对象,采用随机数字表法随机分入常规ESD组（对照组,n=28）和钛夹联合尼龙绳牵引组（试验组,n=31）。比较两组患者的黏膜下补充注射次数、ESD手术时间、病灶面积、黏膜剥离时间、单位时间切除率、病灶完整切除率以及手术并发症等情况。结果 试验组黏膜下补充注射次数少于对照组[（2.3±1.1）次比（3.7±1.4）次,t=4.557,P＜0.001];试验组的病灶面积和对照组相比差异无统计学意义 [（12.7±2.6）cm2比（11.7±2.7）cm2,t=1.485,P=0.143];试验组ESD手术时间[（72.4±24.7）min比（93.6±28.9）min,t=3.043,P=0.004]和黏膜剥离时间[（67.7±23.3）min比（88.2±28.3）min,t=3.054,P=0.003]短于对照组,单位时间切除率高于对照组[（20.2±3.2）mm2/min比（14.3±3.4）mm2/min,t=6.879,P＜0.001]。两组患者的一次性完整切除率均为100.0%。两组患者均未出现穿孔及术后出血等,试验组术中出血率低于对照组[19.4%（6/31）比35.7%（10/28）, χ2=1.992,P=0.158]。结论 使用钛夹联合尼龙绳牵引辅助技术可降低胃角ESD的技术难度、缩短操作时间、降低术中出血可能,具有较好的应用价值。     

新型磁力锚导引系统在内镜黏膜下剥离术中的应用:动物预实验

目的 评估新型磁力锚导引系统在猪模型内镜黏膜下剥离术（ESD）中的应用价值及安全性。方法 2名熟练ESD操作者在2只实验猪直肠进行磁力锚牵引辅助下ESD,记录分析操作时间、切除效率、完整切除率、并发症等。结果 共完成ESD操作5例,病灶开始标记至完整剥离平均时间为26.6 min,单位时间切除率（0.38±0.1）cm2/min。病灶均完整切除且无穿孔和迟发性出血发生。结论 磁力锚牵引辅助ESD能有效暴露黏膜下层,提供直视下切除,是一项安全有效的辅助技术。     

C型切开法内镜黏膜下剥离术在直肠神经内分泌肿瘤中的应用研究

目的评价C型切开法内镜黏膜下剥离术(C-type endoscopic submucosal dissection, C-ESD)治疗直肠神经内分泌肿瘤(neuroendocrine tumors, NEN)的临床效果。方法回顾性分析2018年1月—2021年7月期间在福建省泉州市第一医院内窥镜室行ESD治疗的55例直肠NEN患者资料, 按治疗方案分为C-ESD组(28例)与传统ESD组(27例), 比较两组剥离时间、剥离速度、黏膜下层注射次数、整块切除率、治愈性切除率及术后并发症发生率情况。结果两组基本资料比较差异均无统计学意义(P>0.05)。C-ESD组剥离时间(13.8±4.2)min, 传统ESD组为(19.9±3.9)min, 差异有统计学意义(t=5.649, P<0.001);C-ESD组剥离速度(0.08±0.04)cm2/min, 快于传统ESD组的(0.06±0.04)cm2/min(t=2.218, P=0.031);C-ESD组黏膜下注射次数2(1, 2)次, 少于传统ESD组的3(2, 3)次, 差异有统计学意义(Z=-8.701, P<0...     

带线钛夹在胃异位胰腺内镜黏膜下剥离术中的应用价值

目的评价带线钛夹辅助牵引技术在胃异位胰腺内镜黏膜下剥离术（ESD）治疗中的使用效果和安全性。方法2013年5月至2016年2月,在第三军医大学新桥医院消化内科行ESD治疗,且术后病理确诊的62例胃异位胰腺（均为单发黏膜下来源）患者的病例资料纳入回顾性分析,对比分析使用带线钛夹辅助牵引技术组（观察组,n=36）和传统ESD组（对照组,n=26）的剥离时间、剥离过程中黏膜下层的暴露情况、并发症发生情况及随访结果。结果62例均成功施行ESD治疗。剥离时间观察组明显短于对照组［（19.35±10.34）min比（27.02±14.27）min,t′=2.333,P=0.023］,并且剥离过程中黏膜下层的暴露效果观察组优于对照组。出血发生率观察组为55.6％（20／36）,对照组为61.5％（16／26）,组间差异无统计学意义（χ2=0.222,P=0.638）。观察组无一例发生穿孔,对照组发生1例（3.8％,1／26）,组间差异无统计学意义（P=0.419）。随访期间,62例均无复发。结论ESD治疗胃异位胰腺安全有效,剥离过程中使用带线钛夹辅助牵引技术可有效缩短手术时间,并且有利于减少手术相关并发症的发生。     

Q法自牵引技术在大范围早期食管癌内镜 黏膜下剥离术中的应用研究（含视频）

目的初步报告Q法自牵引辅助内镜黏膜下剥离术(Q-ESD)应用于大范围早期食管癌(EEC)的临床效果。方法回顾性分析2015年1月至2018年12月间在福建省立医院接受ESD治疗的82例大范围EEC(单发病灶>1/2周径或纵径长度>5 cm)患者病例资料,按治疗方案不同分为传统ESD组(n=44)和Q-ESD组(n=38),比较两组操作面积、操作时间、操作速度、整块切除率、完整切除率、并发症情况。结果82例病灶均于内镜下成功整块切除。Q-ESD组和传统ESD组在操作面积[779.8(329.9~2552.5)mm^2比875.7(417.8~1914.8)mm^2,U=155,P=0.636]、操作时间[63(41~177)min比59(42~169)min,U=171,P=0.167]、完整切除率[94.7%(36/38)比93.2%(41/44),χ^2=0.086,P=0.769]方面比较差异无统计学意义。但Q-ESD组操作速度快[14.9(5.4~20.8)mm^2/min比9.0(5.0~19.5)mm^2/min,U=142,P=0.035],固有肌层损伤发生率低[7.9%(3/38)比27.3%(12/44),χ^2=5.123,P=0.023],术后狭窄发生率低[5.3%(2/38)比20.5%(9/44),χ^2=4.051,P=0.044]。除传统ESD组有1例穿孔外,未发生其他不良事件。结论Q-ESD是治疗大范围EEC安全有效的可选策略。     

ADVANTAGES OF USING THIN ENDOSCOPE‐ASSISTED ENDOSCOPIC SUBMUCOSAL DISSECTION TECHNIQUE FOR LARGE COLORECTAL TUMORS

Background: Our purpose was to evaluate the effectiveness of a newly developed non‐invasive traction technique known as thin endoscope‐assisted endoscopic submucosal dissection (TEA‐ESD) procedure for the removal of colorectal laterally spreading tumors (LST). Patients and Methods: A total of 37 LST located in the rectum and distal sigmoid colons of 37 patients were eligible for outcome analysis. Twenty‐one LST were treated with TEA‐ESD and were then retrospectively compared to 16 LST that had previously been treated with standard ESD. Tumor size, en bloc resection rate, procedure time, combined number of different electrical surgical knives used during each procedure and associated complications were evaluated in this case–control study. Results: There was no statistically significant difference in tumor size between the TEA‐ESD group and the ESD control group (43.6 ± 16 mm and 42.4 ± 14 mm, respectively). All LST were successfully resected en bloc in both groups. Procedure duration was shorter for the TEA‐ESD group than the ESD control group, although the difference was not statistically significant (96 ± 53 minutes vs 116 ± 74 minutes; P = 0.18). The percentage of cases in which only one electrical surgical knife was used during the entire procedure was significantly higher in the TEA‐ESD group compared to the ESD control group (85.7% vs 31.3%; P = 0.0005). There were no perforations in the TEA‐ESD group while the ESD control group experienced one perforation. At the present time, TEA‐ESD is limited to the rectum and distal sigmoid colon. Conclusion: It was technically easier, safer and more cost‐effective to perform ESD for LST in the rectum and the distal sigmoid colon using the newly developed TEA‐ESD traction technique.     

经口牵引辅助下内镜黏膜下剥离术治疗早期胃癌及癌前病变的临床研究（含视频）

目的评估经口牵引辅助下内镜黏膜下剥离术（ESD）治疗早前胃癌及癌前病变的疗效和价值。方法2013年7月至2014年8月经胃镜及超声胃镜检查判断局限于黏膜层、未侵及固有肌层的早期胃癌及癌前病变患者44例,其中22例采用经口牵引辅助下ESD治疗（牵引组）,22例采用常规ESD治疗（对照组）,评估2组在病灶开始标记至完整剥离时间、黏膜暴露至完整剥离时间、单位时间切除率、操作困难部位切除时间、一次性整块切除率、一次性完整切除率、出血发生率、穿孔发生率等情况。结果牵引组较对照组,病灶开始标记至完整剥离时间[（48．13±14．65）min比（65．07±29．07）min,P〈0．05]、黏膜暴露至完整剥离时间[（37．47±14．17）min比（54．93±28．16）min,P〈0．05]、操作困难部位切除时间[（33．17±10．65）min比（54．53±46．92）min,P〈0．05]均明显缩短,单位时间切除率[（23．60±14．73）mm。／min比（13．62±8．11）mm。／min,P〈0．05]明显提高。2组一次性整块切除率、一次性完整切除率、出血发生率、穿孔发生率及容易操作部位切除时间相似（P〉0．05）,随访均未见局部复发。结论经口牵引辅助下ESD治疗早期胃癌及癌前病变可提高切除效率,对治疗早期胃癌及癌前病变具有较好的应用价值。     

Efficacy of traction‐assisted colorectal endoscopic submucosal dissection using a clip‐and‐thread technique: A prospective randomized study

Background and Aim

Colorectal endoscopic submucosal dissection (ESD) remains challenging because of technical difficulties, long procedure time, and high risk of adverse events. To facilitate colorectal ESD, we developed traction‐assisted colorectal ESD using a clip and thread (TAC‐ESD) and conducted a randomized controlled trial to evaluate its efficacy.

Methods

Patients with superficial colorectal neoplasms (SCN) ≥20 mm were enrolled and randomly assigned to the conventional‐ESD group or to the TAC‐ESD group. SCN ≤50 mm were treated by two intermediates, and SCN >50 mm were treated by two experts. Primary endpoint was procedure time. Secondary endpoints were TAC‐ESD success rate (sustained application of the clip and thread until the end of the procedure), self‐completion rate by the intermediates, and adverse events.

Results

Altogether, 42 SCN were analyzed in each ESD group (conventional and TAC). Procedure time (median [range]) for the TAC‐ESD group was significantly shorter than that for the conventional‐ESD group (40 [11–86] min vs 70 [30–180] min, respectively; P < 0.0001). Success rate of TAC‐ESD was 95% (40/42). The intermediates’ self‐completion rate was significantly higher for the TAC‐ESD group than for the conventional‐ESD group (100% [39/39] vs 90% [36/40], respectively; P = 0.04). Adverse events included one intraoperative perforation in the conventional‐ESD group and one delayed perforation in the TAC‐ESD group.

Conclusion

Traction‐assisted colorectal endoscopic submucosal dissection reduced the procedure time and increased the self‐completion rate by the intermediates (UMIN000018612).     

Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm

Background and Aims: Colorectal laterally spreading tumors (LST) > 20 mm are usually treated by endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR). Endoscopic piecemeal mucosal resection (EPMR) is sometimes required. The aim of our study was to compare the outcomes of ESD and EMR, including EPMR, for such LST. Methods: A total of 269 consecutive patients with a colorectal LST > 20 mm were treated endoscopically at our hospital from April 2006 to December 2009. We retrospectively evaluated the complications and local recurrence rates associated with ESD, hybrid ESD (ESD with EMR), EMR, and EPMR. Results: ESD and EMR were performed successfully for 89 and 178 LST, respectively: 61 by ESD; 28 by hybrid ESD; 70 by EMR; and 108 by EPMR. Between‐group differences in perforation rates were not significant. Local recurrence rates in cases with curative resection were as follows: 0% (0/56) in ESD; 0% (0/27) in hybrid ESD; 1.4% (1/69) in EMR; and 12.1% (13/107) in EPMR; that is, significantly higher in EPMR. No metastasis was seen at follow up. The recurrence rate for EPMR yielding ≥ three pieces was significantly high (P < 0.001). All 14 local recurrent lesions were adenomas that were cured endoscopically. Conclusions: As for safety, ESD/hybrid ESD is equivalent to EMR/EPMR. ESD/hybrid ESD is a feasible technique for en bloc resection and showed no local recurrence. Although local recurrences associated with EMR/EPMR were seen, which were conducted based on our indication criteria, all local recurrences could obtain complete cure by additional endoscopic treatment.     

Device-assisted traction methods in colorectal endoscopic submucosal dissection and options for difficult cases

Endoscopic submucosal dissection(ESD) procedure has a longer procedure time and higher perforation rate than endoscopic mucosal resection owing to technical complications, including a poor field of vision and inadequate tension for the submucosal dissection plane. Various traction devices were developed to secure the visual field and provide adequate tension for the dissection plane. Two randomized controlled trials demonstrated that traction devices reduce colorectal ESD procedure time compared...     

注水黏膜切开刀推进式内镜黏膜下剥离术快速切除贲门大面积早期癌及其癌前病变的应用初探

探讨推进式内镜黏膜下剥离术(pushing endoscopic submucosal dissection,PESD)在大面积早期贲门癌及其癌前病变中的应用价值。2017年1月—2020年1月在保定市第一中心医院内镜诊疗中心确诊早期贲门癌或高级别上皮内瘤变,且病变最大径>2.0 cm的患者纳入研究。术中应用注水黏膜切...     

Gastrointestinal investigation of iron deficiency anaemia detected by pre-blood donation screening

Abstract

Objectives. Endoscopic submucosal dissection (ESD) is a technically difficult, hazardous, and time-consuming treatment option for superficial neoplasms of the esophagus. The aim of this pilot study was to determine the effectiveness and safety of percutaneous transgastric traction (PTT)-assisted ESD, a method that overcomes the drawbacks of conventional ESD, in a porcine model. Methods. Six domestic pigs (25–30 kg) were used in the study. In each animal, two 5-cm-long esophageal areas were assigned randomly for resection by conventional ESD or PTT-assisted ESD. The PTT method was designed to offer esophageal mucosal traction directed toward the stomach. The wire was introduced into the stomach through a percutaneous transgastric cannula and was fixed on the resected esophageal mucosa. Results. Submucosal dissection in the traction group required only half the time of that in the non-traction group (mean dissection time 596.0 vs. 1127.3 s, respectively; p = 0.01). At necropsy, no differences in the incidence of perforation or bleeding were found between two groups. Conclusions. The PTT method can enhance the speed of submucosal dissection for esophageal ESD to completely remove large areas of resected mucosa.     

Indications for and Technical Aspects of Colorectal Endoscopic Submucosal Dissection

Due to the widespread acceptance of gastric and esophageal endoscopic submucosal dissections (ESDs), the number of medical facilities that perform colorectal ESDs has grown and the effectiveness of colorectal ESD has been increasingly reported in recent years. The clinical indications for colorectal ESD at the National Cancer Center Hospital, Tokyo, Japan include laterally spreading tumor (LST) nongranular type lesions >20 mm and LST granular type lesions >30 mm. In addition, 0-IIc lesions >20 mm, intramucosal tumors with nonlifting signs and large sessile lesions, all of which are difficult to resect en bloc by conventional endoscopic mucosal resection (EMR), represent potential candidates for colorectal ESD. Rectal carcinoid tumors less than 1 cm in diameter can be treated simply, safely, and effectively by endoscopic submucosal resection using a ligation device and are therefore not indications for ESD. The en bloc resection rate was 90%, and the curative resection rate was 87% for 806 ESDs. The median procedure time was 60 minutes, and the mean size for resected specimens was 40 mm (range, 15 to 150 mm). Perforations occurred in 23 (2.8%) cases, and postoperative bleeding occurred in 15 (1.9%) cases, but only two perforation cases required emergency surgery (0.25%). ESD was an effective procedure for treating colorectal tumors that are difficult to resect en bloc by conventional EMR. ESD resulted in a higher en bloc resection rate as well as decreased invasiveness in comparison to surgery. Based on the excellent clinical results of colorectal ESDs in Japan, the Japanese healthcare insurance system has approved colorectal ESD for coverage.