I. Colorectal Cancer and Polyps: The Key Lies in Early Detection

     Colorectal cancer (CRC) is one of the most common cancers in Taiwan. According to statistics from the Ministry of Health and Welfare, more than 16,000 individuals are diagnosed with CRC each year, and the age of onset has been decreasing over time. In 2024, CRC ranked as the third leading cause of cancer-related deaths in Taiwan. The development of CRC often begins with small, asymptomatic adenomatous polyps that may remain undetected for years before transforming into malignancies. Research shows that over 85% of colorectal cancers arise from these adenomatous polyps.

      Risk factors for CRC include advanced age, family history, diabetes, excessive intake of red or processed meats, lack of physical activity and dietary fiber, obesity, smoking, and chronic alcohol consumption. Studies have shown that among individuals with positive fecal immunochemical test (FIT) results, approximately 30%–50% are diagnosed with adenomas or cancer upon follow-up colonoscopy. Therefore, regular FIT and colonoscopy are essential first steps in CRC prevention.

      Moreover, evidence indicates that for every 1% increase in adenoma detection rate (ADR), there is a 3% reduction in the incidence of interval CRC and a 5% reduction in CRC-related mortality. Enhancing screening coverage and ADR thus plays a vital role in improving public health outcomes.

      In Taiwan's national cancer screening program promoted by the National Health Insurance Administration, starting in 2025, free biennial FIT screening will be expanded to include the general population aged 45–74, and individuals aged 40–44 with a first-degree relative (parent, child, or sibling) who has had CRC. A positive FIT result leads to follow-up colonoscopy to detect adenomatous polyps, enabling not only diagnosis but also immediate removal, achieving the goal of “early detection and early treatment.”

II. Endoscopic Submucosal Dissection (ESD): A Minimally Invasive Strategy for Early Colorectal Cancer

      When larger adenomas or early-stage colorectal cancers are detected, traditional treatment typically involves surgical resection of a bowel segment. However, this approach may require longer hospital stays, delayed recovery, and even the possibility of colostomy with poor quality of life. In recent years, the technique of endoscopic submucosal dissection (ESD) has rapidly evolved, providing a safe and minimally invasive alternative.

    ESD allows for the precise en-bloc removal of lesions from the bowel wall without external incisions or disruption of the abdominal cavity. Patients recover quickly, often being discharged within one to two days post-procedure. According to large international multicenter studies, for early CRC lesions without lymph node metastasis risk, ESD achieves en-bloc resection rates exceeding 90%, and R0 (complete pathological) resection rates of 80%–90%. The curative rate of ESD is comparable to that of traditional surgery. Major complications such as perforation or bleeding occur in about 2%–5% of cases and are usually manageable endoscopically, rarely requiring surgical intervention. The minimally invasive nature of ESD results in faster recovery, shorter hospital stays, and better post-treatment quality of life.

III. Far Eastern Memorial Hospital on the Global Stage: Live ESD Demonstration by Leading Experts

     Far Eastern Memorial Hospital (FEMH) is committed to advancing high-quality endoscopic and minimally invasive therapies. On June 13, 2025, FEMH, in collaboration with the Ultrasonography and Endoscopy Center, the Department of Anesthesiology, and the Division of Gastroenterology and Hepatology (Figure 1), co-hosted the Hong Kong University Advanced Endoscopy Workshop (Figure 2). Led by Dr. Chen-Shuan Chung, the Director of the Advanced Endoscopy Unit, the event featured joint teaching demonstrations with renowned endoscopy experts from Asia.

    Participants included Professor Dong Hoon Yang from Asan Medical Center in South Korea, Professor Stephan Tsao from Tan Tock Seng Hospital in Singapore, and Professors Thomas Lui and Wai Keung Leung from the University of Hong Kong (Figure 3). The event was conducted via real-time video streaming, with experts from different countries taking turns to demonstrate advanced techniques for minimally invasive resection of complex colorectal tumors (Figure 4).

   Dr. Chen-Shuan Chung performed a live demonstration of the technically demanding water-pressure ESD technique, successfully removing a 10 cm laterally spreading tumor from the colon (Figure 5). The use of water-jet expansion improved the surgical field and maneuverability, helping reduce the risk of perforation and bleeding while also shortening the procedure time. This showcased FEMH’s advanced endoscopic skill and commitment to safety.

    This cross-regional live broadcast across Taiwan, Hong Kong, Korea, and Singapore highlighted the professional capabilities of FEMH’s endoscopy center and multidisciplinary teams. It also demonstrated that Taiwan's endoscopic techniques are now on par with world-class standards. Beyond its clinical relevance, the event served as a platform for high-level international collaboration and education. FEMH will continue to strengthen global partnerships, promote clinical research and training, and deliver cutting-edge, safe, and high-quality care to patients.

Figure1：June 13, 2025, FEMH, in collaboration with the Ultrasonography and Endoscopy Center, the Department of Anesthesiology, and the Division of Gastroenterology and Hepatology

Figure 2/Figure3：Far Eastern Hospital co-organized the Advanced Endoscopy Workshop of the University of Hong Kong and conducted joint teaching demonstrations with leading endoscopy experts from Hong Kong, South Korea and Singapore.

Figure 4/Figure 5：Dr. Chen-Shuan Chung  personally demonstrated the highly challenging "Water-pressure Submucosal Dissection (ESD)" procedure, successfully removing a large, flat, 10-centimeter colorectal tumor.