Advanced endoscopic resection in the colon: recent innovations, current limitations and future directions

Abstract

The major health burden of colorectal cancer is reduced by colonoscopic polypectomy. The majority of polyps encountered are diminutive in size and easily removed; however, endoscopic removal of lesions >20 mm in size is also effective and safe. Techniques have progressed, advancing the boundaries of endoscopic therapy to include resection of circumferential lesions and selected submucosal invasive cancers. While there are cost and safety advantages over surgical management, specific limitations of endoscopic resection remain, chiefly bleeding, perforation and recurrence. Recent studies highlight the utility of risk stratification and demonstrate the effectiveness of endoscopic treatment of complications; however, strategies for prevention remain elusive. Prediction of submucosal invasive cancers through systematic assessment of lesion morphology and surface pattern is now established. Harnessing submucosal invasive cancer prediction and risk stratification allows a shift toward lesion-specific therapy, the next paradigm in the management of advanced colonic lesions.

The size, morphology, site, and access score predicts critical outcomes of endoscopic mucosal resection in the colon

“…Colonoscopy was performed using Olympus 180 or 190 series, high definition, variable-stiffness colonoscopes (180 /190 PCF/CF; Olympus, Tokyo, Japan). A standardized and previously described inject-and-resect EMR technique was used [11]. Most cases used a microprocessor-controlled electrosurgical generator (Endocut effect 3, VIO 300D; Erbe Elektromedizin, Tübingen, Germany) with fractionated current.…”

Endoscopic resection of subtotal or completely circumferential laterally spreading colonic adenomas: technique, caveats, and outcomes

“…All residual adenoma after EMR of C-LSL was small or diminutive in size and readily treated endoscopically without adverse events. Adherence regarding SC1 surveillance is an important component of LSL treatment by piecemeal EMR [19]. Without this, cure cannot be assured.…”

Impact of en bloc resection on long-term outcomes after endoscopic mucosal resection: a matched cohort study

“…2) was performed using the standard EMR technique as has been described previously in detail. [17][18][19][20] e-EMR was defined as removal of all macroscopically visible adenomatous tissue with a single snare excision. If further snare excisions were required, this was classified as p-EMR.…”