Outcomes of endoscopic resection of large colorectal neoplasms: An Australian experience

Abstract

Endoscopic resection of large colorectal neoplasms is safe and effective even for very large benign neoplasms. When the lesion is endoscopically resectable this should be the preferred treatment.

The target sign: an endoscopic marker for the resection of the muscularis propria and potential perforation during colonic endoscopic mucosal resection

“…The outcome of perforation after endoscopic resection is dependent on endoscopic expertise, time to diagnosis, surgical support, and patient factors such as age, comorbidities, and expectations. 14,[17][18][19] In the 10 target sign patients (Table 1) from the 445 procedures performed, we have demonstrated that early identification and endoscopic closure can reliably treat cases of EMR-associated perforation or deep resection without the need for a significant inpatient admission or the need for surgical management. It is highly plausible, although unproven, that had the 7 patients with partial MP resection not been recognized as described and the defects closed endoscopically, then delayed perforation with potentially serious sequelae may have developed in a significant number of patients, if not all.…”

Endoscopic Mucosal Resection with Circumferential Incision for the Treatment of Large Sessile Polyps and Laterally Spreading Tumors of the Colorectum

“…Recent advances in endoscopic technique have enabled the development of procedures such as endoscopic piecemeal mucosal resection (EPMR) and ESD for the removal of large polyps. The mean procedure times for EPMR 13 , 25 and ESD 14 , 25 range from 29 to 55 minutes, and from 70.5 to 108 minutes, respectively. With regard to the complications, the perforation rates for EPMR 11 , 25 , 26 and ESD 13 , 14 , 25 range from 0.8% to 1.3% and 6.2% to 10.0%, respectively.…”

“…As endoscopic submucosal dissection (ESD) has been reported to achieve high en bloc resection rates (84%) 13 and low recurrence rates in the colorectum, it is expected to overcome the limitations of EMR and offer better clinical outcomes. 14 ESD is a modified form of EMR, and has been established as a standard technique for the treatment of early gastric cancers and adenomas.…”

Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis

“…10 Noninvasive lesions, not otherwise specified. 23 Endoscopic resection techniques for 9 operated lesions were not reported, but the ratio of en bloc vs. piecemeal resected lesions at follow-up was estimable. 24 Only the number of invasive lesions was stated.…”