Presentation Information
[JKS2-3]Indications and Limitations of Treatment for Malignant Diseases
Naohisa Yoshida, Reo Kobayashi, Ken Inoue (Department of Endoscopy and Ultrasound, University Hospital, Kyoto Prefectural University of Medicine)
With the widespread implementation of endoscopic screening, the early detection rate of colorectal cancer has significantly improved, and the role of endoscopic treatment is becoming increasingly important. For intramucosal cancers and superficially submucosal invaded cancer, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have become widely adopted as minimally invasive alternatives to surgical resection. EMR is globally recognized as a standard technique; however, piecemeal resection has traditionally been a limitation for large or recurrent lesions. Recent advances such as underwater EMR and precutting EMR have improved the precision and outcomes of the procedure (Yoshida N, et al. Endoscopy 2019;51:871-6). On the other hand, ESD allows en bloc resection regardless of tumor size and provides an accurate pathological diagnosis, although it requires advanced skills and carries a risk of complications such as perforation and delayed bleeding. Nevertheless, the development of the pocket-creation method and traction devices has contributed to reducing the technical difficulty and procedure time, and the introduction of various endoscopic closure techniques has further decreased the risk of adverse events (Yoshida N, et al. Endoscopy 2025;57:354-60). Recently, even delayed perforation can be treated with endoscopic closure (Yoshida N, et al. Dig Dis Sci 2025;70:2404-13). In this presentation, we will provide an overview of current endoscopic techniques for colorectal cancer, their limitations, and future perspectives.