Incomplete Polyp Resection During Colonoscopy—Results of the Complete Adenoma Resection (CARE) Study

Pohl, Heiko; Srivastava, Amitabh; Bensen, Steve P.; Anderson, Peter B.; Rothstein, Richard I.; Gordon, Stuart R.; Levy, L. Campbell; Toor, Arifa; MacKenzie, Todd A.; Rösch, Thomas; Robertson, Douglas J.

doi:10.1053/j.gastro.2012.09.043

Cited by 679 publications

(606 citation statements)

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“…Ez főként a jobb colonfelet érinti, mivel ott gyakoribb a fogazott elváltozás [40]. Erre példa egy 346 polipectomiát összegző vizsgá-lat eredménye, melyben az inkomplett endoszkópos reszekció kockázata jelentősen magasabb volt SSA/P (31,0%), mint klasszikus adenoma (7,2%) esetén [41]. A korai stádiumban nem detektált laesiók tehetők felelőssé továbbá az ún.…”

Section: Prognózisunclassified

Heterogén vastagbéldaganat: a fogazott útvonalon kialakuló, sporadikus laesiók jelentősége a klinikai gyakorlatban

et al. 2018

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A colorectalis daganatra ma már igen heterogén betegségként tekintünk, mely heterogenitást a kialakulásában szerepet játszó genetikai faktorok, molekuláris eltérések, különböző jelátviteli útvonalak, valamint mikro-és makrokörnye-zeti tényezők okoznak. A korábban ismert ,,klasszikus" adenoma-carcinoma szekvencia mellett az elmúlt évtizedben egy másik, alternatív útvonal is felismerésre került. Ezt ,,fogazott" útvonalnak nevezzük, mely az elváltozások kb. egyharmadáért felelős. Ezek a laesiók a molekuláris tulajdonságaikon felül makroszkópos és mikroszkópos képükben és progressziós hajlamukban, illetve prognózisukban is eltérnek a klasszikus útvonal daganataitól. Az alábbi összefog-laló közlemény ezen eltérések molekuláris tulajdonságait, makroszkópos és szövettani jellegzetességeit, illetve klinikai jelentőségét szemlélteti. Orv Hetil. 2018; 159(6): 206-214. Kulcsszavak: vastagbéldaganat, fogazott útvonal, polip, prognózis Colorectal cancer heterogeneity: the clinical impact of sporadic lesions arising via the serrated pathwayToday, colorectal cancer is regarded as a heterogeneous disease. Its heterogeneity is caused by genetic alterations, molecular aberrations, different developing pathways as well as by micro-and macroenviromental agents. In the last decade, beside the classic genetic model for colorectal tumuorgenesis that follows the adenoma-carcinoma sequence, an alternative pathway has been identified. This pathway is called the serrated pathway and it is responsible for approximately one third of all colorectal lesions. Beyond their dissimilar molecular characteristics, these tumours also show different macroscopic and histologic appearance. Moreover, their malignant potency and progressive ability distinguish them from tumours of the classic genetic model. The aim of this review is to summarize the molecular and pathologic features of serrated lesions and the serrated pathway to colorectal cancer and to highlight their clinical impact. Keywords

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Section: Prognózisunclassified

Heterogén vastagbéldaganat: a fogazott útvonalon kialakuló, sporadikus laesiók jelentősége a klinikai gyakorlatban

et al. 2018

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“…[1][2][3] One major advantage of U-EMR is that submucosal injection is not required as: (i) the suctioning of luminal air decreases colonic wall tension; (ii) colonic muscular wall remains circular when it is filled with water; and (iii) water immersion 'floats' the mucosa and submucosa. 2 This technique is also applied to duodenal ampullary and non-ampullary adenomas. 4,5 A 77-year-old man presented with a 10-mm-sized superficial colonic polyp located at the anastomosis site after sigmoidectomy for a sigmoid colon cancer (Fig 1a).…”

Section: Letters Techniques and Imagesmentioning

confidence: 99%

Precutting endoscopic mucosal resection for colorectal lesions

Tamai

Kamba

Sumiyama

2017

Digestive Endoscopy

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Letters, Techniques and Images Standardization of endoscopic resection for colorectal lesions over 10 mm Precutting endoscopic mucosal resection for colorectal lesionsPrecutting endoscopic mucosal resection (EMR) is defined by Japan Gastroenterology Endoscopy Society as a technique in which snaring is done without dissecting the submucosal layer after incising the circumference of the lesion by using a knife for endoscopic submucosal dissection (ESD) or the tip of a snare (Fig. 1).1 Conventional EMR is a common technique for resecting colorectal lesions, and the size of the lesion that can be resected safely en bloc using the conventional EMR technique is regarded as a lesion <20 mm in size. However, a recent study reported that even in cases with a lesion <20 mm in size, the incomplete polyp resection rate that was confirmed by obtaining biopsies from the resection margin was relatively high, particularly for lesions 15-20 mm in size (23.3%) and sessile serrated adenomas/polyps (SSA/P) (31.0%).2 Sakamoto et al.3 examined the efficacy of the precutting EMR technique for large colorectal neoplasia and reported an en bloc resection rate of 83.3% for colorectal lesions 20-30 mm in size; in addition, no perforation was observed. As is well known, a higher en bloc resection rate can provide a lower recurrence rate after endoscopic resection. 4 Controversy still exists regarding whether the ESD technique should be applied for the treatment of large SSA/P; therefore, the application of precutting EMR for colorectal lesions <30 mm in size, especially large SSA/P, may be feasible for clinical practice. Although the perforation rate of precutting EMR has not been reported for a large number of cases and precutting EMR for colorectal lesions with fibrosis should be applied carefully, precutting EMR does not require an additional device when the circumferential incision is made using the tip of a snare. Thus, precutting EMR should be considered an easy method for resecting large colorectal lesions. CONFLICTS OF INTEREST

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“…Once neoplasia is identifi ed, it is also important to completely remove all neo plastic tissue. Th e recent CARE study demonstrated that complete resection of neoplasia is far less common than previously thought ( 18 ). Adjunctive imaging may allow for more careful evaluation of resection margins, leading to more complete polypectomy.…”

Section: Conflict Of Interestmentioning

confidence: 99%

“…Second, neoplasia (either a cancer or precancerous polyp) may have been missed at the time of colonoscopy ( 17 ). Th ird, the neoplastic lesion may have been identifi ed at the time of colonoscopy, but incompletely resected ( 18 ).…”

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Editorial: Interval Cancers: Learning from the Past as We Build for the Future

Dominitz

Robertson²

2013

American Journal of Gastroenterology

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EDITORIALWhile colonoscopy is the gold standard for the evaluation of the colon, research on post-colonoscopy colorectal cancers has increased our awareness of its limitations. In this issue of the Journal , Erichsen et al. provide evidence to suggest that post-colonoscopy colorectal cancers are most likely due to missed cancers at the time of the index colonoscopy, rather than due to aggressive tumor biology. Ultimately, studies demonstrating the shortcomings of colonoscopy are a call to action for the gastroenterology community to develop strategies and new technologies to improve the effectiveness of colonoscopy. Am J Gastroenterol 2013; 108:1341 -1343 doi: 10.1038/ajg.2013 Colorectal cancer screening has seen tremendous evolution over the past several decades. Prior to the mid-to late 1990s, screening colonoscopy was rarely discussed. However, endorsement by multiple professional organizations ( 1 ) followed by the publication of two high-profi le studies demonstrating the feasibility of screening colonoscopy ( 2,3 ) and subsequent Medicare reimbursement led to a rapid rise in its use ( 4 ). But utilization of screening colonoscopy has increased over the past decade ( 5 ) despite the lack of prospective evidence of its eff ectiveness. Rather, support for screening colonoscopy has been largely based upon cost-eff ectiveness models that were predicated upon assumptions that colonoscopy has a sensitivity as high as 95 % for the detection of large polyps and cancers, and may be up to 90 % eff ective at reducing colorectal cancer mortality ( 6 ).However, tandem colonoscopy and computed tomographic colonography studies have taught us that colonoscopy is not as sensitive for neoplasia as we previously believed ( 7,8 ). Results from the National Polyp Study and several retrospective studies suggest that colonoscopy is associated with a 37 -65 % reduction in mortality ( 9 -11 ), much lower than had previously been hypothesized. Moreover, up to 8 % of colorectal cancers are diagnosed within 3 -5 years aft er a colonoscopy ( 12,13 ). At the same time, new noninvasive colorectal cancer screening tests have been introduced, including fecal immunochemical tests (FITs) ( 14 ), computed tomographic colonography and fecal DNA testing ( 15 ). As these tests become increasingly eff ective, we need to carefully consider the role of colonoscopic screening.In order for colonoscopy to attain the position as the preferred screening strategy, we must better understand why interval cancers occur. Th ere are several potential explanations. First, some tumors may be rapidly growing, representing actual new pathology that was not present at the time of the prior colonoscopy ( 16 ). Second, neoplasia (either a cancer or precancerous polyp) may have been missed at the time of colonoscopy ( 17 ). Th ird, the neoplastic lesion may have been identifi ed at the time of colonoscopy, but incompletely resected ( 18 ).While there are a number of studies describing the magnitude of the interval cancer problem, few attempt to distinguish between th...

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Incomplete Polyp Resection During Colonoscopy—Results of the Complete Adenoma Resection (CARE) Study

Cited by 679 publications

References 29 publications

Heterogén vastagbéldaganat: a fogazott útvonalon kialakuló, sporadikus laesiók jelentősége a klinikai gyakorlatban

Heterogén vastagbéldaganat: a fogazott útvonalon kialakuló, sporadikus laesiók jelentősége a klinikai gyakorlatban

Precutting endoscopic mucosal resection for colorectal lesions

Editorial: Interval Cancers: Learning from the Past as We Build for the Future

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