Large Sessile Serrated Polyps Can Be Safely and Effectively Removed by Endoscopic Mucosal Resection

Rao, Aarti K.; Soetikno, Roy; Raju, Gottumukkala S.; Lum, Phillip; Rouse, Robert V.; Sato, Tohru; Titzer-Schwarzl, Diane; Aisenberg, James; Kaltenbach, Tonya

doi:10.1016/j.cgh.2015.10.013

Cited by 53 publications

(44 citation statements)

References 20 publications

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“…SSP s are easier to remove by endoscopic resection as compared to adenomas as they do not have submucosal fibrosis and are loosely attached to deeper layers making lifting easy after injection. Rao et al 30 showed, in a large cohort of 251 SSP (>10 mm), EMR could safely remove polyps with only 3.6% recurrence rate after mean follow-up of 17.8±15.4 months. All recurrences (median size, 4 mm) could be managed by endoscopic resection.…”

Section: Endoscopic Mucosal Resection Of Large Ser-rated Lesionsmentioning

confidence: 99%

Optimal Endoscopic Treatment and Surveillance of Serrated Polyps

Gupta

East

2020

Gut and Liver

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Serrated polyps are considered precursor lesions that account for 15% to 30% of colorectal cancers, and they are overrepresented as a cause of interval cancers. They are difficult to detect and resect comprehensively; however, recent data suggest that high definition endoscopy, chromoendoscopy (via spray catheter, pump or orally), narrow band imaging, split-dose bowel preparation and a slower withdrawal (>6 minutes) can all improve detection. Cold snare resection is effective and safe for these lesions, including cold snare piecemeal endoscopic mucosal resection, which is likely to become the standard of care for lesions >10 mm in size. Sessile serrated lesions ≥10 mm in size, those exhbiting dysplasia, or traditional serrated adenomas increase the chance of future advanced neoplasia. Thus, a consensus is emerging: a surveillance examination at 3 years should be recommended if these lesions are detected. Serrated lesions likely carry equivalent risk to adenomas, so future guidelines may consider serrated class lesions and adenomas together for risk stratification. Patients with serrated polyposis syndrome should undergo surveillance every 1 to 2 years once the colon is cleared of larger lesions, and their first degree relatives should undergo screening every 5 years starting at age 40.

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Section: Endoscopic Mucosal Resection Of Large Ser-rated Lesionsmentioning

confidence: 99%

Optimal Endoscopic Treatment and Surveillance of Serrated Polyps

Gupta

East

2020

Gut and Liver

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“…This problem is easily overcome by submucosal injection of a contrast agent and use of a high-definition colonoscope, which in combination allow easy tracking of the perimeter during resection (36,37). The size threshold for performing submucosal injection in SSA/Ps should be 10 to 15 mm (38). Piecemeal cold snare excision of nondysplastic SSA/P, which is facilitated by submucosal injection, is an evolving area of interest.…”

Section: The Vocabulary Of Serrated Lesionsmentioning

confidence: 99%

“…The Paris IIc depressed lesionsM A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 13are both rare and enormously important because of their very high prevalence of high-grade dysplasia and cancer relative to all other morphologies(41). The prevalence of cancer in both Paris Type I and IIa lesions is extremely low, whereas the prevalence of high-grade dysplasia and cancer in IIc lesions can reach 50%(38). Depression is characterized by a sharp drop off from the elevated to depressed portions, and the total area of the depression is substantial.…”

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confidence: 99%

The colonoscopist's guide to the vocabulary of colorectal neoplasia: histology, morphology, and management

Rex

Hassan

Bourke

2017

Gastrointestinal Endoscopy

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Prevention of colorectal cancer by colonoscopy requires effective and safe insertion technique, high level detection of precancerous lesions, and skillful use of curative endoscopic resection techniques. Lesion detection, characterization, use of appropriate resection methods, prediction of cancer at colonoscopy, and management of malignant polyps, all depend on an accurate and complete understanding of an extensive vocabulary describing the histology and morphology of neoplastic colorectal lesions. Incomplete understanding of vocabulary terms can lead to management errors. We provide a colonoscopist's perspective on the vocabulary of colorectal neoplasia, and discuss the interaction of specific terms with management decisions.

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“…Endoscopic mucosal resection (EMR) has been shown to be safe and effective for large colorectal polyps, with the additional benefits of avoidance of surgery and cost-savings [1][2][3][4][5][6][7][8][9][10][11]. As a result, it is considered standard of care over the invasive alternative of surgical resection for benign lesions, which is supported by the recommendations of the European Society of Gastrointestinal Endoscopy (ESGE) [2].…”

Section: Introductionmentioning

confidence: 99%

Impact of observational training on endoscopic mucosal resection outcomes and competency for large colorectal polyps: single endoscopist experience

et al. 2020

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Background and study aims Endoscopic mucosal resection (EMR) is standard treatment for large colorectal polyps. However, it is a specialized technique with limited data on the effectiveness of training methods to acquire this skill. The aim of this study was to evaluate the impact of observational training on EMR outcomes and competency in an early-stage endoscopist. Patients and methods A single endoscopist completed comprehensive EMR training, which included knowledge acquisition and direct observation of EMR cases, and proctored supervision, during the third year of gastroenterology fellowship. After training, EMR was independently attempted on 142 consecutive, large (i. e., ≥ 20 mm), non-pedunculated colorectal polyps between July 2014 and December 2017 (mean age 61.7 years; mean polyp size 30.4 mm; en-bloc resection 55 %). Surveillance colonoscopy for evaluation of residual neoplasia was available for 86 % of the cases. Three primary outcomes were evaluated: endoscopic assessment of complete resection, rate of adverse events (AEs), and rate of residual neoplasia on surveillance colonoscopy. Results Complete endoscopic resection was achieved in 93 % of cases, the rates of AEs and residual neoplasia were 7.8 % and 7.3 %, respectively. The rate of complete resection remained stable (at 85 % or greater) with increasing experience while rates of AEs and residual neoplasia peaked and decreased after 60 cases. Conclusions An early-stage endoscopist can acquire the skills to perform effective EMR after completing observational training. At least 60 independent EMRs for large colorectal polyps were required to achieve a plateau for clinically meaningful outcomes.

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Large Sessile Serrated Polyps Can Be Safely and Effectively Removed by Endoscopic Mucosal Resection

Abstract: Inject-and-cut EMR is a safe and effective technique for the resection of SSPs. Less than 5% of patients have a local recurrence, which is usually small and can be treated endoscopically.

Cited by 53 publications

References 20 publications

Optimal Endoscopic Treatment and Surveillance of Serrated Polyps

Optimal Endoscopic Treatment and Surveillance of Serrated Polyps

The colonoscopist's guide to the vocabulary of colorectal neoplasia: histology, morphology, and management

Impact of observational training on endoscopic mucosal resection outcomes and competency for large colorectal polyps: single endoscopist experience

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