Current research status of endoscopic submucosal dissection for colorectal neoplasms.

Endoscopic submucosal dissection (ESD) has been applied to, and gradually standardized for, early gastric cancers; however, it has not yet been widely used for treatment of colorectal neoplasms. Compared with gastric ESD, the thinner colorectal wall and winding nature of the colon make colorectal ESD a much more difficult operative technique. Despite greater risks of postoperative complications, particularly perforation of the colon, more and more endoscopists are making an effort to study this new technique in terms of its capability of larger neoplastic resection, higher en bloc resection rate and lower local recurrence rate of neoplasms in comparison with other endoscopic treatments. Thus, colorectal ESD may become the standard treatment for early colorectal neoplasms in the future. This review article discusses the current research on endoscopic submucosal dissection for colorectal neoplasms. Please see supplementary files for the accompanying video ESD with snare.

Natural orifice transluminal endoscopic surgery: new minimally invasive surgery come of age.

Although in the past two decades, laparoscopic surgery, considered as a great revolution in the minimally invasive surgery field, has undergone major development worldwide, another dramatic surgical revolution has quietly appeared in recent years. Ever since Kalloo's first report on transgastric peritoneoscopy in a porcine model in 2004, interest in a new surgical procedure named natural orifice transluminal endoscopic surgery (NOTES) has blossomed worldwide. Considering that a NOTES procedure could theoretically avoid any abdominal incision, operation-related pain and scarring, many surgeons and endoscopists have been enthusiastic in their study of this new technique. In recent years, several NOTES studies have been carried out on porcine models and even on humans, including transvaginal cholecystectomy, transgastric appendectomy, transvaginal appendectomy, and transvesical peritoneoscopy. So what is the current situation of NOTES and how many challenges do we still face? This review discusses the current research progress in NOTES.