Polypectomy Techniques for Difficult Colon Polyps

Mönkemüller, Klaus; Neumann, Helmut; Fry, Lucía C.; Iveković, Hrvoje; Malfertheiner, Peter

doi:10.1159/000177020

Cited by 18 publications

(15 citation statements)

References 40 publications

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“…13,14 Improvements in endoscopic techniques may have led to an increasing willingness to remove multiple polyps as well as larger polyps, both of which increase the chances of finding a malignant polyp and subsequent referral for surgery. 15 Finally, national guidelines dictating management of malignant polyps evolved and may have helped in standardization of care. 16 Hassan et al conducted a pooled analysis of 1900 patients with a diagnosis of malignant polyps collected from published literature on the subject, many of whom underwent surgical resection (53.7%).…”

Section: Discussionmentioning

confidence: 99%

Trends, patterns, and outcomes in the management of malignant colonic polyps in the general population of the United States

Wasif¹,

Etzioni²,

Maggard³

et al. 2010

Cancer

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BACKGROUND: Colonoscopic screening has increased detection of malignant colonic polyps (MPs). The goal of this study was to analyze trends and patterns in the surgical treatment of MPs and to assess outcomes as measured by lymph node retrieval and patient survival. METHODS: The Surveillance, Epidemiology, and End Results (SEER) registry was queried to identify 19,743 patients with MPs from 1988 to 2003. RESULTS: The majority of MPs were present in the sigmoid and descending colon (54%), and 38% were tubular, 40% were tubulovillous, and 22% were villous. During the study period, the incidence of MPs increased from 29% to 42% and surgical resection (SR) was increasingly used for treatment, from 54% to 70%. Predictors of SR were aged <70 years (odds ratio [OR], 1.3; 95% confidence interval [95% CI], 1.2-1.4), high-grade tumors (OR, 1.5; 95% CI, 1.2-1.9), diagnosis in 1999 through 2003 (OR, 1.7; 95% CI, 1.5-1.9), villous subtype (OR, 2.3; 95% CI, 2.0-2.6), and right colon location (OR, 8.1; 95% CI, 7.0-9.4). In patients undergoing SR, the mean and median number of lymph nodes was only 4 and 1, respectively. A significant percentage of patients (49%) had no lymph nodes retrieved and a worse overall survival at 5 years compared with patients who had at least 1 lymph node examined (64% vs 74%; P <.001). CONCLUSIONS: MPs appear to be increasing in incidence, and there is a trend toward increased use of SR for treatment. However, patients undergoing SR for MPs undergo suboptimal assessment of lymph nodes, with a detrimental impact on survival. Adequate lymphadenectomy and lymph node evaluation are crucial to improve outcomes in patients with these potentially curable lesions.

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Section: Discussionmentioning

confidence: 99%

Trends, patterns, and outcomes in the management of malignant colonic polyps in the general population of the United States

Wasif¹,

Etzioni²,

Maggard³

et al. 2010

Cancer

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“…A "difficult" colon polyp can be defined as any polyp that is difficult to remove for an average endoscopist. A "difficult" colorectal polyp may be characterized by the size, morphology, location, number and the difficult assessment of the grade of malignancy before removal [5][6][7][8]. The main characterization of the "difficult" colorectal polyp is summarised by Table 1.…”

Section: "Difficult" Colon Polyp: Definitionmentioning

confidence: 99%

“…Induration, ulceration, friability, fixity, and non-lifting sign are the major endoscopic, macroscopic features of malignancy, while polyp size, villous histology and high-grade dysplasia on initial biopsy are strong histologic predictors of malignancy [8]. [5][6][7][8]. Table 2.…”

Section: General Considerationsmentioning

confidence: 99%

“…It has been suggested that the main steps leading to a successful polypectomy are the following: accurately locate the polyp, determine the number of polyps and size of polyps, analyse the polyp's shape and surface, position the polyp before resection, estimate polyp resectability and asses the skill of the endoscopist. Moreover, all essential equipment and accessories necessary for successful polypectomy should be available [5][6][7][8]. In clinical practice, most polyps identified at colonoscopy are small and not malignant, and therefore, are amenable to almost all endoscopists to conventional polypectomy.…”

Section: General Considerationsmentioning

confidence: 99%

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The “Difficult” Colorectal Polyps and Adenomas: Practical Aspects

Herszényi¹

2018

Dig Dis

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Background: Colonoscopy is the gold standard for adenoma detection. All endoscopists who perform colonoscopy must by mandate be skilled to perform polypectomy. However, there are significant differences between endoscopists in terms of the polyp detection rate and in the effectiveness of polypectomy. Summary: Most polyps identified can be managed by conventional polypectomy and do not pose a significant challenge for resection to an adequately skilled and trained endoscopist. Up to 15% of polyps may be considered “difficult”, unsuitable for conventional endoscopic removal because of size, morphology, site, or access grade. Endoscopist-, patient- and polyp-specific viewpoints influence the management of difficult polyps. Advances in endoscopic resection techniques have led to extended indications for polypectomy. Conventional endoscopic removal of colorectal polyps is associated with a small but not negligible incidence of complications, most commonly bleeding and perforation. Advanced techniques for difficult polyps can potentially cause significant, even life-threatening complications. In addition, in the presence of “difficult” polyps, complications are more common. Key Messages: Multiple techniques are now available for the resection of difficult polyps. The endoscopist should individualize the appropriate approach for the treatment of difficult polyp in order to maximize oncological safety, efficacy and minimize complications and unnecessary surgery.

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“…Up until the last decade, the treatment options for these lesions have been: (1) repeat colonoscopy, reassessment, and possible attempt at colonoscopic removal in the endoscopy suite, (2) formal transabdominal segmental colectomy, (3) transabdominal wedge-type colon wall excision, or (4) observation alone. Most surgeons, when faced with this situation, will perform a "cancer type" segmental colectomy because of the well-known possibility that the supposedly benign polyp may harbor an invasive cancer.…”

mentioning

confidence: 99%

Laparoscopic-Facilitated Colonic Endoscopic Mucosal Resection and Endoscopic Submucosal Resection of Adenomas: Techniques to Avoid Segmental Colectomy

Whelan

2011

Journal of Gastrointestinal Surgery

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Polypectomy Techniques for Difficult Colon Polyps

Cited by 18 publications

References 40 publications

Trends, patterns, and outcomes in the management of malignant colonic polyps in the general population of the United States

Trends, patterns, and outcomes in the management of malignant colonic polyps in the general population of the United States

The “Difficult” Colorectal Polyps and Adenomas: Practical Aspects

Laparoscopic-Facilitated Colonic Endoscopic Mucosal Resection and Endoscopic Submucosal Resection of Adenomas: Techniques to Avoid Segmental Colectomy

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