Evolving management of colorectal polyps

Abstract

Advances in endoscopic technology have led to increased success in colorectal cancer (CRC) screening and polyp management, with reduction of CRC incidence and mortality. Despite these advances, CRC is still one of the leading causes of cancer deaths, and half of all CRC develops from lesions that were missed during colonoscopy while one-fifth of CRC arise from prior incomplete resection. Techniques to improve polyp detection are needed, along with optimization of complete resection of any abnormal lesions that are found. This article will review the currently available endoscopic resection techniques and will discuss where they fit in the management of polyps of different sizes and types, such as pedunculated versus nonpedunculated, and those with or without suspected invasion.

Insights into Biochemical Sources and Diffuse Reflectance Spectral Features for Colorectal Cancer Detection and Localization

“…This, along with the significant morbidity and cost associated with standard surgery and associated adjuvant treatment modalities has led to the widespread adoption of screening methods to detect cancer at an early stage [ 3 ]. This is paralleled by a proliferation of minimally invasive methods such as Endoscopic Mucosal Resection (EMR), Endoscopic Submucosal Dissection (ESD), Transanal endoscopic microsurgery (TEM) and Transanal Minimally Invasive Surgery (TAMIS) to deal with these early lesions [ 4 ]. Currently, standard CRC screening tests such as the detection of blood in the stool have high false positive rates and accurate CRC detection is achieved by colonoscopy followed by relevant biopsies.…”

Deep Cuts: Colonic Polyp Resection Using Standard Endoscopic Mucosal Resection vs. Precutting Endoscopic Mucosal Resection Using a Novel Disk Tip Snare

“…Colonic polyps, particularly those larger than 20 mm, cannot be satisfactorily removed en bloc with endoscopic mucosal resection (EMR)-the preferred modality for large lesionseven in expert hands [1]. Failure to resect completely prevents the histopathologic margins from being evaluated appropriately, which in turn is linked to higher recurrence rates, shorter surveillance intervals, and the chance of additional endoscopic interventions.…”

A risk stratification for nodal metastasis in T1 colorectal cancer after successful therapeutic endoscopy

“…In polyps 20 mm with high-risk features for early cancer, including Kudo pit pattern type IV or V I , and depressed or nongranular lesions, ESD is preferred because it more likely leads to complete en bloc resection with a negative histologic margin, even for much larger lesions. 6 ESD is pursued over regular EMR when a lesion of any size is radically unremovable with snare EMR, such as tumors with submucosal fibrosis, local residual or recurrent early carcinomas after unsuccessful endoscopic resection, and nonpolypoid dysplasia/sporadic tumors in patients with inflammatory bowel disease. 7 Applying the proposed algorithm for T1 CRC patients treated endoscopically may have some limitations.…”