Colorectal cancer is the third most common cancer among both men and women in the United States and the second leading cause of cancer death. Endoscopic submucosal dissection (ESD) is an innovative advanced endoscopic therapy for superficial gastrointestinal neoplasms which is rapidly becoming standard of care particularly in Asia. ESD was first developed for the resection of early gastric cancers; yet ESD for colon tumors has gained increasing attention in recent years. The advantage of ESD over conventional endoscopic resection lies in its potential to achieve en bloc resection regardless of tumor size, leading to more precise histological evaluation and greater potential for cure. Selecting appropriate patients for this procedure involves identifying colorectal cancers with nul risk of lymph node spread. For colorectal ESD to engraft in the United States, the prevalence of such early stage lesions must be defined so that centers of excellence can be developed for high volume clinical practice to offer patients the safest and most efficacious outcomes. This review discusses the endoscopic staging of colorectal neoplasms, indications for colorectal ESD, and the epidemiology of early stage ESD-amenable colorectal cancer in America to better define an opportunity for this important minimally invasive therapy. 1. Introduction: Endoscopic Submucosal Dissection and Colorectal Neoplasia Cancers of the colon and rectum are the third most common cancers among both men and women in the United States and the second leading cause of cancer death [1]. Endoscopic submucosal dissection (ESD) is an innovative advanced endoscopic approach to superficial gastrointestinal neoplasms, which is becoming the standard treatment, particularly in advanced Asian medical centers [2, 3]. ESD was first utilized in the resection of early gastric neoplasms; yet ESD for colon tumors has gained increasing attention in recent years [4–9]. The advantage of ESD over conventional endoscopic mucosal resection is that it has the potential for a high rate of en bloc resection regardless of tumor size, leading to precise histological evaluation of the specimen margins and a lower recurrence rate at long-term followup [5, 10–12]. In one of the largest follow-up studies to date evaluating ESD for colorectal epithelial neoplasms including both adenomas and carcinomas, the 5-year overall/disease-specific survival was greater than 95% [10]. In an analysis of several studies totaling greater than 700 cases of ESD for colorectal cancer, local recurrence rates averaged approximately 1% [7]. Finally,
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