JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection

TLDR

Colorectal ESD has become common, treating early carcinomas and precarcinomatous adenomas, yet evidence for many guideline areas remains scarce. The paper aims to develop practical guidelines for preoperative diagnosis and endoscopic treatment selection to ensure safe and effective colorectal ESD/EMR in general hospitals. The guidelines were compiled by major Japanese gastroenterology societies using evidence‑based methods, focusing on diagnostic and therapeutic strategies while excluding specific procedural details, and recommendations were largely set by expert consensus due to limited evidence.

Abstract

Colorectal endoscopic submucosal dissection (ESD) has become common in recent years. Suitable lesions for endoscopic treatment include not only early colorectal carcinomas but also many types of precarcinomatous adenomas. It is important to establish practical guidelines in which the preoperative diagnosis of colorectal neoplasia and the selection of endoscopic treatment procedures are properly outlined, and to ensure that the actual endoscopic treatment is useful and safe in general hospitals when carried out in accordance with the guidelines. In cooperation with the Japanese Society for Cancer of the Colon and Rectum, the Japanese Society of Coloproctology, and the Japanese Society of Gastroenterology, the Japan Gastroenterological Endoscopy Society has recently compiled a set of colorectal ESD/endoscopic mucosal resection (EMR) guidelines using evidence-based methods. The guidelines focus on the diagnostic and therapeutic strategies and caveat before, during, and after ESD/EMR and, in this regard, exclude the specific procedures, types and proper use of instruments, devices, and drugs. Although eight areas, ranging from indication to pathology, were originally planned for inclusion in these guidelines, evidence was scarce in each area. Therefore, grades of recommendation were determined largely through expert consensus in these areas.