内镜黏膜切除术（EMR）与内镜黏膜下剥离术（ESD）都具有侵袭小、术后疼痛轻微、康复快等特点,可用于早期胃肠道黏膜及黏膜下病变的微创治疗。EMR一般不适用于病灶直径〉20mm的病变,研究表明其整块切除率为42.9%,完全切除率为32.9%。ESD对于较大病灶可完全整块剥离,且复发率低,但对设备和技术要求较高。目前在ESD与EMR的基础上出现了改进,如ESD-S（ESD with snare，ESD联合圈套器法）、EMR—P（EMR with precutting，预环切EMR法）。
Endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR)are useful therapeutic techniques for colorectal tumors.Currently,new techniques based on these procedures are available,such as endoscopic submucosal dissection with snare(ESD-S)and endoscopic mucosal resection with pre-cutting(EMR-P).For the excision of colorectal tumors,each of these techniques has been characterized as having a high total resection rate,low recurrence rate or low complication rate.In this study,we analysed clinical trials that had recently been published,to search for the most appropriate endoscopic treatment for colorectal tumors.Our search results revealed the following:for a tumor with a diameter less than 20mm,the surgeon should choose ESD,ESD-S,EMR-P or EMR,depending on the condition of the tumor.On the other hand,to excise a tumor larger than 20mm in diameter,ESD and ESD-S should be the first choices.However,if the patient has a high risk of complications due to ESD or ESD-S,the use of EMR-P would be suitable.Because of the high possibility of canceration in a tumor larger than 20mm in diameter,EMR is not the optimal endoscopic treatment for the excision of a colorectal tumor,due to a low total resection rate and a high recurrence rate.
Shilun CaiYunshi ZhongPinghong ZhouJianmin XuLiqing Yao
