Endoscopic Management of Complex Colorectal Polyps: Current Insights and Future Trends

Mann, Rupinder; Gajendran, Mahesh; Umapathy, Chandraprakash; Perisetti, Abhilash; Goyal, Hemant; Saligram, Shreyas; Echavarria, Juan

doi:10.3389/fmed.2021.728704

Cited by 19 publications

(17 citation statements)

References 229 publications

(213 reference statements)

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“…Overall, we achieved a high en bloc resection rate and a low complication rate. The en bloc resection rate was 97.3%, which was consistent with reports worldwide (79.4–99.5%) [ 9 ]. The largest retrospective case series of 1259 colorectal lesions by the Hiroshima group showed an en bloc resection rate of 92.6% [ 10 ], while a meta-analysis of 97 studies showed an en bloc resection rate of 91% for colorectal ESD [ 11 ].…”

Section: Discussionsupporting

confidence: 90%

Endoscopic submucosal dissection for colorectal polyps: outcome determining factors

et al. 2022

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Background Endoscopic submucosal dissection (ESD) has gained increasing popularity in the management of complicated colorectal polyps. However, clinical outcomes for ESD have remained highly inconsistent worldwide. This study investigated and analysed factors that significantly affect ESD outcomes. Methods We conducted a single-centred retrospective study on 220 colorectal polyps removed by ESD from 1st January 2016 to 31st December 2020. Data were collected and retrieved from clinical records. Variables studied included patient demographics, ESD technicalities and polyp characteristics. The primary outcome was completeness of resection based on en bloc and R0 resection rates. The secondary outcomes were recurrence, complications and hospital stay. Further analysis was performed for significant outcome determining factors. Results The en bloc resection and R0 resection rates were 97.3% and 65% respectively. Intraprocedural and delayed perforation rates were 3.2% and 0.5% respectively. Intraprocedural and delayed bleeding rates were both 1.8%. Post-polypectomy syndrome rate was 2.7%. The median hospital stay was 4 days. Submucosal fibrosis was a significant determining factor for lower en bloc resection ( p = 0.004), lower R0 resection ( p = 0.002), intraprocedural perforation ( p = 0.001), intraprocedural bleeding ( p = 0.025) and post-polypectomy syndrome ( p = 0.039). Hybrid snaring was associated with lower en bloc resection ( p < 0.001), while longer ESD time was associated with lower R0 resection ( p = 0.003) and post-polypectomy syndrome ( p = 0.025). Other significant factors for post-polypectomy syndrome included young age ( p = 0.021) and large polyp size ( p = 0.018). Secondary analysis showed that submucosal fibrosis was significantly associated with non-granular lesions ( p < 0.001) and prior biopsy ( p = 0.003). Conclusion Submucosal fibrosis, hybrid snaring, ESD time, age and polyp size were significant outcome determining factors for ESD. By identifying these factors, strategies may be formulated to improve ESD outcomes.

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Section: Discussionsupporting

confidence: 90%

Endoscopic submucosal dissection for colorectal polyps: outcome determining factors

et al. 2022

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“…For early T1 lesions, even with submucosal involvement, advances in endoscopic interventions mean these lesions can be adequately treated with polypectomy, endoscopic mucosal or submucosal resections[ 68 - 70 ]. Endoscopic mucosal resections and endoscopic submucosal resections are indicated in lesions with suspicious characteristics based on mucosal pit patterns, polyp morphology and other endoscopic aspects of colorectal cancers[ 68 - 70 ]. These procedures are both safe and less expensive than surgery[ 68 - 70 ].…”

Section: Management Of Colorectal Cancermentioning

confidence: 99%

“…Endoscopic mucosal resections and endoscopic submucosal resections are indicated in lesions with suspicious characteristics based on mucosal pit patterns, polyp morphology and other endoscopic aspects of colorectal cancers[ 68 - 70 ]. These procedures are both safe and less expensive than surgery[ 68 - 70 ]. In most of these cases histopathological assessment reveals adequate margins, and no further management is needed[ 68 - 70 ].…”

Section: Management Of Colorectal Cancermentioning

confidence: 99%

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Clinical presentation, management, screening and surveillance for colorectal cancer during the COVID-19 pandemic

Akbulut¹,

Hargura²,

Garzali³

et al. 2022

WJCC

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Management of colorectal cancer (CRC) was severely affected by the changes implemented during the pandemic, and this resulted in delayed elective presentation, increased emergency presentation, reduced screening and delayed definitive therapy. This review was conducted to analyze the impact of the coronavirus disease 2019 (COVID-19) pandemic on management of CRC and to identify the changes made in order to adapt to the pandemic. We performed a literature search in PubMed, Medline, Index Medicus, EMBASE, SCOPUS, Reference Citation Analysis ( ) and Google Scholar using the following keywords in various combinations: Colorectal cancer, elective surgery, emergency surgery, stage upgrading, screening, surveillance and the COVID-19 pandemic. Only studies published in English were included. To curtail the spread of COVID-19 infection, there were modifications made in the management of CRC. Screening was limited to high risk individuals, and the screening tests of choice during the pandemic were fecal occult blood test, fecal immunochemical test and stool DNA testing. The use of capsule colonoscopy and open access colonoscopy was also encouraged. Blood-based tests like serum methylated septin 9 were also encouraged for screening of CRC during the pandemic. The presentation of CRC was also affected by the pandemic with more patients presenting with emergencies like obstruction and perforation. Stage migration was also observed during the pandemic with more patients presenting with more advanced tumors. The operative therapy of CRC was altered by the pandemic as more emergencies surgeries were done, which may require exteriorization by stoma. This was to reduce the morbidity associated with anastomosis and encourage early discharge from the hospital. There was also an initial reduction in laparoscopic surgical procedures due to the fear of aerosols and COVID-19 infection. As we gradually come out of the pandemic, we should remember the lessons learned and continue to apply them even after the pandemic passes.

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“…About 70% of colorectal cancers originate from adenomatous polyps. In contrast, 25–30% of colorectal cancer cases originate from sessile serrated polyps [ 9 ]. If colon adenomas are removed by colonoscopic polypectomy, patient mortality is reduced by 53% [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Rapid Polyp Classification in Colonoscopy Using Textural and Convolutional Features

Yeh

Tang

et al. 2022

Healthcare

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Colorectal cancer is the leading cause of cancer-associated morbidity and mortality worldwide. One of the causes of developing colorectal cancer is untreated colon adenomatous polyps. Clinically, polyps are detected in colonoscopy and the malignancies are determined according to the biopsy. To provide a quick and objective assessment to gastroenterologists, this study proposed a quantitative polyp classification via various image features in colonoscopy. The collected image database was composed of 1991 images including 1053 hyperplastic polyps and 938 adenomatous polyps and adenocarcinomas. From each image, textural features were extracted and combined in machine learning classifiers and machine-generated features were automatically selected in deep convolutional neural networks (DCNN). The DCNNs included AlexNet, Inception-V3, ResNet-101, and DenseNet-201. AlexNet trained from scratch achieved the best performance of 96.4% accuracy which is better than transfer learning and textural features. Using the prediction models, the malignancy level of polyps can be evaluated during a colonoscopy to provide a rapid treatment plan.

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Endoscopic Management of Complex Colorectal Polyps: Current Insights and Future Trends

Cited by 19 publications

References 229 publications

Endoscopic submucosal dissection for colorectal polyps: outcome determining factors

Endoscopic submucosal dissection for colorectal polyps: outcome determining factors

Clinical presentation, management, screening and surveillance for colorectal cancer during the COVID-19 pandemic

Rapid Polyp Classification in Colonoscopy Using Textural and Convolutional Features

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