Endoscopic submucosal dissection (ESD) is anew endoscopic technique for the resection of superficial gastrointestinal neoplasias. It is a wonderful technique since it enables the resection of relatively large and difficult lesions which are impossible to treat by conventional endoscopic mucosal resection techniques. Moreover the flex knife is a relatively safe and maneuverable device for colorectal ESD due to its soft and flexible nature. Although ESD is the most advanced technique of therapeutic endoscopy, the colon still presents intrinsic risks and high technical difficulties. Therefore thorough knowledge and training is indispensable in its treatment. The operator should address from relatively easy lesions, preferably from gastric lesion, to gradually step up according to his skill to relatively more difficult cases such as colorectal lesions.
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