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

Abstract

Endoscopic resection of C-LSL is feasible and safe. Minor residual adenoma is common but endoscopically treatable with long-term cure. Symptomatic stricturing amenable to balloon dilation may occur. Empiric surgical referral for C-LSL based on extensive circumferential involvement may be avoided.ClinicalTrials.gov NCT01368289.

Endoscopic resection of colorectal circumferential and near-circumferential laterally spreading lesions: outcomes and risk of stenosis

“…The patient had also received radiotherapy for prostate cancer in the past which may have contributed to the development of stenosis with a less extensive defect. Also, in keeping with other studies, we found that several patients with stenosis were asymptomatic [3][4][5][6]. Interestingly, we found that stenosis in such patients generally improves spontaneously with evident improvement at subsequent surveillance endoscopy and none progressed to develop symptoms.…”

“…However, 1 patient with only 50% circumference defect at the rectosigmoid developed an asymptomatic stenosis. The patient had diverticulosis and Tutticci et al have postulated diverticular disease with luminal narrowing may play a role in the development of stenosis [6]. The patient had also received radiotherapy for prostate cancer in the past which may have contributed to the development of stenosis with a less extensive defect.…”

“…Almost all reports on outcomes of ER resulting in near or total circumferential defects and the risk of stenosis originate from Japanese expert centres focusing solely on ESD, some focusing exclusively on rectal tumours [3][4][5]. Only one other western centre has reported on ER of near or total circumferential lesions [6].…”

“…The safety and efficacy of expert colorectal endoscopic resection (ER) has been established for large lesions in general [2]. In recent years, ER for lesions with characteristics once considered contraindications for ER, such as near-circumferential adenomas, has been reported [3][4][5][6]. Although the true incidence is unclear, many patients with large colorectal adenomas without invasive cancer are still treated with radical surgery [7].…”

“…Although ESD is increasingly used in western expert centres, due to the complexity of ER of nearcircumferential lesions, it is likely that even these units would employ a combination of piecemeal endoscopic mucosal resection (pEMR) and ESD. Only one western unit has reported outcomes from ER of circumferential and nearcircumferential colorectal adenomas, exclusively using pEMR for resection [6].…”