Endoscopic submucosal dissection and its potential role in the management of early colorectal neoplasia in UK

In Europe, colorectal cancer is the most common newly diagnosed cancer and the second most common cause of cancer deaths, accounting for approximately 436 000 incident cases and 212 000 deaths in 2008. National screening programmes will increase the number of early (pT1) cancers detected. pT1 cancers are those showing invasion through the muscularis mucosae into the submucosa but not into the muscularis propria. Microstaging of pT1 cancer is crucial in predicting those cases less likely to cause nodal disease and that will be cured with endoscopic resection alone. The submucosal extent and other histological features predict the risk of nodal disease, and for this reason, en bloc resection is highly desirable. Endoscopic submucosal dissection enables en bloc resection of mucosal and submucosal disease and could reduce the need for surgery in some cases by definitive initial resection.