JOCS

The aim of the Comprehensive Surgery is to publish original research articles of the highest scientific and clinical value at the international level in all surgical fields.

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Letter to the Editor
Rectal ESD in the shadow of prior endoscopic intervention: the fibrotic pitfall
Endoscopic submucosal dissection (ESD) has gained increasing recognition as an organ-preserving therapeutic modality for large superficial rectal neoplasms. It has emerged as a particularly valuable treatment option for laterally spreading tumors (LSTs) and lesions with suspected superficial submucosal invasion, offering superior en bloc and R0 resection rates compared to conventional endoscopic mucosal resection (EMR).


1. Ohata K, Kobayashi N, Sakai E, et al. Long-term outcomes after endoscopic submucosal dissection for large colorectal epithelial neoplasms: a prospective, multicenter, cohort trial from Japan. Gastroenterology. 2022;163(5):1423-1434.e2. doi:10.1053/j.gastro.2022.07.002
2. Cecinato P, Lisotti A, Azzolini F, et al. Left colonic localization, non-granular morphology, and pit pattern independently predict submucosal fibrosis of naïve colorectal neoplasms before endoscopic submucosal dissection. Surg Endosc. 2023;37(4):3037-3045. doi:10.1007/s00464-022-09828-0
3. Kuroha M, Shiga H, Kanazawa Y, et al. Factors associated with fibrosis during colorectal endoscopic submucosal dissection: does pretreatment biopsy potentially elicit submucosal fibrosis and affect endoscopic submucosal dissection outcomes? Digestion. 2021;102(4):590-598. doi: 10.1159/000510145
4. Pimentel-Nunes P, Libânio D, Bastiaansen BAJ, et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline-Update 2022. Endoscopy. 2022;54(6):591-622. doi:10.1055/a-1811-7025
5. Kamigaichi Y, Oka S, Tanaka S, et al. Factors for conversion risk of colorectal endoscopic submucosal dissection: a multicenter study. Surg Endosc. 2022;36(8):5698-5709. doi:10.1007/s00464-022-09250-6
6. Vohra I, Gopakumar H, Meyyappan A, et al. Endoscopic submucosal dissection for colorectal neoplasms: is the west catching up? Cancers (Basel). 2026;18(14):2190. doi:10.3390/cancers18142190
Volume 4, Issue 3, 2026
Page : 77-78
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