Meta-analysis and systematic review of colorectal endoscopic mucosal resection

Puli, Srinivas R.; Kakugawa, Yasuo; Gotoda, Takuji; Antillon, Daphne; Saito, Yutaka; Antillon, Mainor R.

doi:10.3748/wjg.15.4273

Cited by 84 publications

(51 citation statements)

References 32 publications

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“…Therefore, all colonic lesions C6 mm should be either resected or ablated [4]. From the results of meta-analyses, polypectomy [4] and EMR [6]/ ESD [7] can be considered the preferred less invasive treatments for colorectal neoplasia [8,9]. However, for flat and depressed lesions, endoscopic resection is recommended, since the incidence of carcinoma is even higher in lesions that are B5 mm in size than in polypoid lesions [6,10].…”

Section: Introductionmentioning

confidence: 99%

Evidence-based clinical practice guidelines for management of colorectal polyps

et al. 2015

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Background Recently in Japan, the morbidity of colorectal polyp has been increasing. As a result, a large number of cases of colorectal polyps that are diagnosed and treated using colonoscopy has now increased, and clinical guidelines are needed for endoscopic management and surveillance after treatment. Methods Three committees [the professional committee for making clinical questions (CQs) and statements by Japanese specialists, the expert panelist committee for rating statements by the modified Delphi method, and the evaluating committee by moderators] were organized. Ten specialists for colorectal polyp management extracted the specific clinical statements from articles published between 1983 and September 2011 obtained from PubMed and a secondary database, and developed the CQs and statements. Basically, statements were made according to the GRADE system. The expert panel individually rated the clinical statements using a modified Delphi approach, in which a clinical statement receiving a median score greater than seven on a nine-point scale from the panel was regarded as valid. Results The professional committee created 91CQs and statements for the current concept and diagnosis/treatment of various colorectal polyps including epidemiology, screening, pathophysiology, definition and classification, diagnosis, treatment/management, practical treatment, complications and surveillance after treatment, and other colorectal lesions (submucosal tumors, nonneoplastic polyps, polyposis, hereditary tumors, ulcerative colitis-associated tumor/carcinoma). Conclusions After evaluation by the moderators, evidence-based clinical guidelines for management of colorectal polyps have been proposed for 2014.

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Section: Introductionmentioning

confidence: 99%

Evidence-based clinical practice guidelines for management of colorectal polyps

et al. 2015

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“…Advances in technology, such as magnification lenses, narrow band imaging and chromoendoscopy have increased the detection yield for early cancers during colonoscopy [15][16][17] . Lesions characterized as early cancers can be endoscopically resected at the same sitting and can be curative [18,19] . However, the advantages of colonoscopy are not only limited to the detection and treatment of early cancers.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing quality of bowel preparation for colonoscopy

Romero

Mahadeva

2013

WJGE

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Recent technological advances in colonoscopy have led to improvements in both image enhancement and procedural performance. However, the utility of these technological advancements remain dependent on the quality of bowel preparation during colonoscopy. Poor bowel preparation has been shown to be associated with lower quality indicators of colonoscopy performance, such as reduced cecal intubation rates, increased patient discomfort and lower adenoma detection. The most popular bowel preparation regimes currently used are based on either Polyethylene glycol-electrolyte, a non-absorbable solution, or aqueous sodium phosphate, a lowvolume hyperosmotic solution. Statements from various international societies and several reviews have suggested that the efficacy of bowel preparation regimes based on both purgatives are similar, although patients' compliance with these regimes may differ somewhat. Many studies have now shown that factors other than the type of bowel preparation regime used, can influence the quality of bowel preparation among adult patients undergoing colonoscopy. These factors can be broadly categorized as either patient-related or procedure-related. Studies from both Asia and the West have identified patient-related factors such as an increased age, male gender, presence of co-morbidity and socioeconomic status of patients to be associated with poor bowel preparation among adults undergoing routine out-patient colonoscopy. Additionally, procedure-related factors such as adherence to bowel preparation instructions, timing of bowel purgative administration and appointment waiting times for colonoscopy are recognized to influence the quality of colon cleansing. Knowledge of these factors should aid clinicians in modifying bowel preparation regimes accordingly, such that the quality of colonoscopy performance and delivery of service to patients can be optimised.

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“…During a mean follow up of 40 months, benign recurrences were observed in only 3% of patients [Doniec et al 2003]. A recent meta-analysis which included 25 studies, however, showed lower pooled rates of complete curative en bloc resections at 59% [Puli et al 2009]. Our experience (unpublished data) suggests that the incidence of polyp recurrence after en bloc resection is 60% less compared with piecemeal resection and additional use of APC did not improve the recurrence rates.…”

Section: Squamous Dysplasia and Cancermentioning

confidence: 65%