Endoscopic resection of unresectable polyps

Abstract

Most colorectal cancers arise from adenomas. Size is considered one of the main criteria in evaluating resectability, and improved therapeutic equipment safely permits resection of very large polyps. The resectability of polyps depends on macroscopic characteristics, such as histopathologic classifi cation and the technique used. Macroscopic pattern is important to appreciate the resectability of a polyp. The use of new endoscopic techniques allows large endoscopic resection. Endoscopic mucosal resection can be considered a safe and curative option for nonpolypoid colorectal neoplasms. This technique is limited to lesions around 2 cm in diameter, and longer lesions often need to be resected by piecemeal mucosectomy. Endoscopic submucosal dissection is considered by Japanese experts to be the optimal technique for selected TisN0 colorectal lesions. Endoscopic submucosal dissection enables the resection of virtually any nonprotruding lesions of the colon when the depth of invasion into the submucosa is less than 1000 μm.

Application des recommandations ANAES de la Coloscopie en France: Enquête de pratique

“…Improvement in practitioner awareness of this issue is, therefore, to be expected. The endoscopic and histological parameters for endoscopic mucosectomy of superficial cancers of the digestive tract were not known to gastroenterologists [8]. However, this is a new technique that requires specific information acquired in the context of continuing medical education.…”