Endoscopic management of early colorectal cancer

Abstract

The endoscopic treatment of cancerous and precancerous lesions in the gastrointestinal (GI) tract has experienced major breakthroughs in the past years. Colonoscopy plays a major role in the prevention and detection of colorectal cancer patients and is used for diagnosis and treatment of early colorectal cancer and its precursors. Improvements in colonoscopy preparation, new techniques of adenoma detection, and recent progress in endoscopic imaging methods are providing higher-quality results and thus reducing the incidence and mortality of the disease. During the past decade, endoscopic resection techniques have evolved, and cancers confined to the mucosal and superficial submucosal layers can now be resected via flexible endoscopes. Therefore, it is important to understand the indications and limitations of endoscopic resection, to determine whether the cancer can be curatively resected, and assess the risk of lymph node metastasis, which precludes endoscopic treatment.The successful removal of an early colorectal cancer requires advanced techniques and expertise. Currently, many options are available such as snare polypectomy, that is the most frequently used, and endoscopic mucosal resection (EMR), that is an efficient method with low complication rate for the treatment of most benign and advanced lesions in the GI tract, but carries a risk of incomplete resection and recurrence of early cancer. However, with the introduction of precutting EMR or hybrid ESD, endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFTR), the scope of lesions eligible for curative endoscopic treatment has been widened significantly. These resection techniques have the potential to spare surgical treatment to a selected population of patients. We will review these different endoscopic techniques.