Large polyps: Pearls for the referring and receiving endoscopist

Abstract

Polyps are precursors to colorectal cancer, the third most common cancer in the United States. Large polyps, i.e.,, those with a size ≥ 20 mm, are more likely to harbor cancer. Colonic polyps can be removed through various techniques, with the goal to completely resect and prevent colorectal cancer; however, the management of large polyps can be relatively complex and challenging. Such polyps are generally more difficult to remove en bloc with conventional methods, and depending on level of expertise, may consequently be resected piecemeal, leading to an increased rate of incomplete removal and thus polyp recurrence. To effectively manage large polyps, endoscopists should be able to: (1) Evaluate the polyp for characteristics which predict high difficulty of resection or incomplete removal; (2) Determine the optimal resection technique ( e.g., snare polypectomy, endoscopic mucosal resection, endoscopic submucosal dissection, etc. ); and (3) Recognize when to refer to colleagues with greater expertise. This review covers important considerations in this regard for referring and receiving endoscopists and methods to best manage large colonic polyps.

Usefulness of Contrast-Enhanced Endoscopic Ultrasound (CH-EUS) to Guide the Treatment Choice in Superficial Rectal Lesions: A Case Series

“…We present the first case series of rectal lesions where the use of contrast agent during endoscopic ultrasound is proposed as an additional tool to support therapeutic decision making. Large rectal lesions can be difficult to examine properly even in expert hands [ 16 ]. Lesions’ morphologies should guide therapeutic decision, but it was shown that the agreement is only moderate, even among experts [ 29 ].…”

“…Endoscopic ultrasound (EUS) plays a role in the locoregional staging of rectal cancer both for the evaluation of the degree of infiltration (T) and mostly for lymph node assessment staging (N) [ 8 ]. The accuracy of the EUS in T staging is, however, extremely variable, ranging from 63% to 96% depending on the study [ 16 , 17 , 18 , 19 , 20 ]. A review published by Puli et al in 2009 [ 21 ] showed that EUS had sensibility and specificity, respectively, of 87.8% and 98.3% for T1 rectal lesions.…”

Precision endoscopy in colorectal polyps' characterization and planning of endoscopic therapy

“…The accuracy of EUS in T staging for rectal cancer varies significantly, ranging from 63% to 96%. [66][67][68][69][70] Notably, EUS underestimates the degree of infiltration in up to 18% of cases and overestimates locoregional staging in up to 17.3%. 71 Several studies have compared the accuracy of EUS with magnifying chromoendoscopy to evaluate the depth of invasion in rectal lesions.…”

“…The accuracy of EUS in T staging for rectal cancer varies significantly, ranging from 63% to 96% 66–70 . Notably, EUS underestimates the degree of infiltration in up to 18% of cases and overestimates locoregional staging in up to 17.3% 71 …”