“Unresectable” polyp management utilizing advanced endoscopic techniques results in high rate of colon preservation

Wickham, Carey; Wang, Jennifer; Mirza, Kasim L.; Norén, Erik; Shin, Joongho; Lee, Sang W.; Cologne, Kyle G.

doi:10.1007/s00464-021-08499-7

Cited by 8 publications

(9 citation statements)

References 28 publications

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“…In our recent evaluation of patients referred with “endoscopically unresectable” polyps, 60% were able to be completely resected without the need for CELS/FLEX or the need for formal colectomy. 20 For complex polyps suspected to be incompletely resected with standard endoscopic techniques, laparoscopic ports are placed first. Triangulation of the colonic lesion with incorporation of the plan for resection is vital in planning port-site placement ( Fig.…”

Section: Operative Techniquesmentioning

confidence: 99%

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Combined Endoscopic–Laparoscopic Surgery (CELS) in the Management of Early Colorectal Lesions

Wlodarczyk

Lee

2023

Digestive Disease Interventions

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Over 14 million colonoscopies are performed annually in the United States. With the growing number of colonoscopies comes corresponding increases in the rates of colectomies performed for benign polyps. These advanced adenomas have the potential, if removed early, to promote decreased rates of colon cancer and improve patient survival. Difficult to resect polyps may be located at colonic flexures, tortuous turns in the colon, the ileocecal valve, or the appendiceal orifice presenting a unique challenge to endoscopic resection. Various advanced endoscopic techniques are now available for the resection of these polyps such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection, but these techniques have a steep learning curve and are technically challenging. For the community colorectal surgeon, relatively simpler options include combined endoscopic and laparoscopic surgery (CELS) and full-thickness laparo-endoscopic colonic excision (FLEX) for either the endoscopic or laparoscopic removal of challenging polyps. The FLEX procedure resembled a nonanatomic wedge resection of the colon with polyp, while CELS resembles a laparoscopically augmented EMR. With the technical success rate for CELS reportedly between 74 and 97%, the postoperative complication rate of less than 5%, and polyp recurrence rates bordering less than 2%, these procedures have the capacity to safely facilitate the complete removal of difficult-to-resect endoscopic polyps. The purpose of this review is to both provide recommendations for CELS and FLEX utilization for the resection of polyps and describe our operative techniques and tips and tools for increasing the efficacy of these procedures.

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Section: Operative Techniquesmentioning

confidence: 99%

“…24 Since the development of the first FLEX technique, several other techniques have been developed for the full-thickness resection of cecal lesions. 20 These techniques center around sleeve or wedge resection of the cecum. The increased diameter of the cecum allows for wedge resection without pathologic narrowing of the colon.…”

Section: Operative Techniquesmentioning

confidence: 99%

Combined Endoscopic–Laparoscopic Surgery (CELS) in the Management of Early Colorectal Lesions

Wlodarczyk

Lee

2023

Digestive Disease Interventions

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“…In the evaluation of patients referred with “endoscopically unresectable” polyps in one single-center study, 60% were able to be completely resected endoscopically without the need for CELS, FLEX or colectomy. 17 Preoperative endoscopic evaluation of the polyp by the primary surgeon can remove this uncertainty from the equation. This will allow the surgeon to confirm the lesion's location as well as its resectability, as this may prove to be different than what was reported in the referral.…”

Section: Operative Techniquesmentioning

confidence: 99%

“…21 Since the first FLEX technique, other techniques have been developed for full-thickness resection of cecal lesions. 17 These techniques center around sleeve or wedge resection of the cecum.…”

Section: Operative Techniquesmentioning

confidence: 99%

Combined Endoscopy–Laparoscopy Surgery: When and How to Utilize This Tool

Wlodarczyk

Gupta

Lee

2023

Clin Colon Rectal Surg

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Combined endoscopic and laparoscopic surgery (CELS) has been used to resect colon polyps since the 1990s. These colon-sparing techniques, however, have not yet been widely adopted. With the evolution of technology in both diagnosing and treating colon cancer, colorectal surgeons should strive for a diverse and complete armamentarium through which they can best serve their patients. In this article, we hope to provide clarity on CELS by discussing three topics: (1) the history and fruition of CELS; (2) the techniques involved in CELS; and (3) the utility of CELS within different clinical scenarios. Our goal is to educate readers and stimulate consideration of CELS in select patients who might benefit greatly from these techniques.

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“…One way to overcome this is the use of propensity score matching. Wickham et al [ 11 ] evaluated 95 patients referred because of endoscopically unresectable colorectal lesions and compared them to 190 propensity score-matched controls. Endoscopic resection was achieved in 66 (70%) of patients with a reduced hospital stay, a lower unplanned 30-day readmission rate, and fewer postoperative complications (4.2% vs 33.9%; P < 0.001) compared to surgery.…”

Section: Why Should Endoscopic Resection and Not Surgery Be The Thera...mentioning

confidence: 99%

How to avoid overtreatment of benign colorectal lesions: Rationale for an evidence-based management

Bustamante-Balén

2022

World J Gastroenterol

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Implementing population-based screening programs for colorectal cancer has led to an increase in the detection of large but benign histological lesions. Currently, endoscopic mucosal resection can be considered the standard technique for the removal of benign lesions of the colon due to its excellent safety profile and good clinical results. However, several studies from different geographic areas agree that many benign colon lesions are still referred for surgery. Moreover, the referral rate to surgery is not decreasing over the years, despite the theoretical improvement of endoscopic resection techniques. This article will review the leading causes for benign colorectal lesions to be referred for surgery and the influence of the endoscopist experience on the referral rate. It will also describe how to categorize a polyp as complex for resection and consider an endoscopist as an expert in endoscopic resection. And finally, we will propose a framework for the accurate and evidence-based treatment of complex benign colorectal lesions.

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“Unresectable” polyp management utilizing advanced endoscopic techniques results in high rate of colon preservation

Cited by 8 publications

References 28 publications

Combined Endoscopic–Laparoscopic Surgery (CELS) in the Management of Early Colorectal Lesions

Combined Endoscopic–Laparoscopic Surgery (CELS) in the Management of Early Colorectal Lesions

Combined Endoscopy–Laparoscopy Surgery: When and How to Utilize This Tool

How to avoid overtreatment of benign colorectal lesions: Rationale for an evidence-based management

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