Endoscopic resection: when is EMR/ESD sufficient?

Endoscopic treatment of malignant lesions in the gastrointestinal tract can be treated curatively if the risk for lymph node metastasis is lower than 1%. In the lower gi-tract (colon and rectum) the low risk criteria for this situation are well-defined (G1/G2, LO, invasion depth ≤1000μm). However, en-bloc R0-resection is also mandatory. Benign lesions such as lateral spreading tumors (granular-type) can be also treated with piecemeal EMR, however, recurrence rate is up to 30%. All other cases, regardless of size, such as non-granular type lesions or mixed type lesions should be treated with endoscopic submucosal dissection. The definitive histopathology of the resected specimen allows further decision (e.g., surgery if invasion depth of tumor is >1000μm).