We read with great interest the paper of Bahin et al comparing piecemeal endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for large colorectal laterally spreading lesions (LSLs) from a medico-economic point of view.1 Since the expanded use of ESDs in Japan that began in the early 2000s, a debate still persists in Western countries about the absolute need for en bloc resection of large colorectal lesions with a low risk of submucosal cancer.2 3 ESDs are associated with a high en bloc resection rate, low risk of recurrence and perfect pathological analysis.4 Defenders of piecemeal EMR point out the higher risk of ESD, the long duration of procedures, the discrepancies between Eastern and Western series, and the low proportion of lesions with superficial submucosal cancer.5 They also point out the good results of wide-field (WF)-EMR for complete eradication even when several sessions are needed.6 Economic reasons are not often mentioned, although they could be considered …

中文翻译：

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内镜黏膜下剥离术还是内镜下黏膜切除术治疗大的结直肠横向扩散病变？科学和经济数据仍然缺乏

我们饶有兴趣地阅读了 Bahin 等人的论文，该论文从医学经济学的角度比较了分段式内镜黏膜切除术 (EMR) 和内镜黏膜下剥离术 (ESD) 对大的结直肠横向扩散病变 (LSL) 的影响。 1日本的 ESD 始于 2000 年代初，但在西方国家仍然存在关于绝对需要整块切除黏膜下癌风险低的大结直肠病变的争论。2 3 ESD 与高整块切除率相关， 4 零碎EMR的拥护者指出ESD风险高、手术时间长、东西方序列差异大、浅表黏膜下癌病变比例低。5 他们还指出，即使需要多次治疗，广域 (WF)-EMR 也能取得良好的效果，以彻底根除。6 经济原因并不常被提及，尽管可以考虑……