Colorectal ESD Is More Effective and Safer in Asian Countries

Endoscopic submucosal dissection (ESD) was developed in Japan for treatment of early gastric cancer, and its use has expanded to colorectal lesions. There are several obstacles to ESD uptake in western countries.

In a systematic review and meta-analysis, investigators assessed outcomes of colorectal ESD in Asian and non-Asian countries. Among 109 studies of colorectal ESD identified, 97 involved standard ESD techniques and 12 involved hybrid techniques (generally involving submucosal injection, circumferential incision into the submucosa, and subsequent snare resection).

Among 17,073 lesions treated in Asian countries, compared with 1691 treated in non-Asian countries, rates of R0 resection (clear vertical and lateral margins) and en bloc res…