Avoiding colorectal resection for polyps: is CELS the best method?

Sharma, SK; Lee, Sang W.; Milsom, Jeffrey W.

doi:10.1007/s00464-015-4279-6

Cited by 25 publications

(21 citation statements)

References 43 publications

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“…The colonoscopic-assisted laparoscopic resection involves endoscopic localisation of the polyp margins. Feasible preliminary data are promising: 70-87% of polyps not amenable to routine snare polypectomy can be successfully removed with these techniques [8,35,48].…”

Section: Combined Methods: Future Directionsmentioning

confidence: 99%

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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Section: Combined Methods: Future Directionsmentioning

confidence: 99%

The “Difficult” Colorectal Polyps and Adenomas: Practical Aspects

Herszényi¹

2018

Dig Dis

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“…33 A recent systematic review includes 18 studies with a total of 532 patients. 36 EMR, ESD, and full-thickness excisions were performed heterogeneously throughout these studies. Successful CELS resections ranged from 58 to 100%, and studies with more than 20 patients demonstrated higher success rates (74-91%).…”

Section: Recent Literaturementioning

confidence: 99%

“…[38][39][40] Some surgeons choose to use a laparoscopic bowel clamp at the terminal ileum, or just proximal to the lesion. 34,36 However, others have found this to be an unnecessary step when using CO 2 endoscopy. 33,38 EMR versus ESD versus Full-Thickness Resection…”

Section: Intraoperative Colonoscopymentioning

confidence: 99%

“…[18][19][20]41 In a systematic review of the literature, EMR and ESD techniques have been used successfully and safely as coordinated CELS procedures. 36 In addition to full-thickness resection (wedge or segmental), these three techniques are used heterogeneously within individual studies, and there are no direct or randomized comparisons of simple polypectomy with EMR, ESD, or segmental resections. EMR and ESD require a more advanced skill-set and, likely for that reason, are not as widely used.…”

Section: Intraoperative Colonoscopymentioning

confidence: 99%

“…11 Many described procedures include performing a leak test routinely following closure of the colostomy. 36 The bowel can be clamped proximally and insufflated with air, or indigo carmine can be instilled into the lumen to look for smaller leaks. 30 If there is concern for full-thickness electrocautery injury, laparoscopic Lembert sutures are placed to reinforce the area of concern.…”

Section: Mesenteric Polypsmentioning

confidence: 99%

See 2 more Smart Citations

Combined Endoscopic Laparoscopic Surgery Procedures for Colorectal Surgery

Placek

Nelson

2017

Clinics in Colon and Rectal Surgery

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Colonoscopy is the standard of care for screening and surveillance of colorectal cancers. Removal of adenomatous polyps prevents the transformation of adenomas to potential adenocarcinoma. While most polyps are amenable to simple endoscopic polypectomy, difficult polyps that are large, broad-based, or located in haustral folds or in tortuous colon segments can present a challenge for endoscopists. Traditionally, patients with endoscopically unresectable polyps have been referred for oncologic surgical resection due to the underlying risk of malignancy within the polyp; however, the majority of these polyps are benign on final pathology. Combined endoscopic laparoscopic surgery can help facilitate endoscopic removal of difficult lesions, or allow the surgeon to select the correct laparoscopic approach for polyp excision. Current literature suggests that these procedures are safe and effective and can potentially save patients from the morbidity of laparotomy and segmental colectomy.

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Laparoscopic-Assisted Polypectomy

Norén

Lee

2019

Advanced Techniques in Minimally Invasive and Robotic Colorectal Surgery

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Avoiding colorectal resection for polyps: is CELS the best method?

Cited by 25 publications

References 43 publications

The “Difficult” Colorectal Polyps and Adenomas: Practical Aspects

The “Difficult” Colorectal Polyps and Adenomas: Practical Aspects

Combined Endoscopic Laparoscopic Surgery Procedures for Colorectal Surgery

Laparoscopic-Assisted Polypectomy

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