Polyp Resection - Controversial Practices and Unanswered Questions

Abstract

Detection and complete removal of precancerous neoplastic polyps are central to effective colorectal cancer screening. The prevalence of neoplastic polyps in the screening population in the United States is likely >50%. However, most persons with neoplastic polyps are never destined to develop cancer, and do not benefit for finding and removing polyps, and may only be harmed by the procedure. Further 70–80% of polyps are diminutive (≤5 mm) and such polyps almost never contain cancer. Given the questionable benefit, the high-cost and the potential risk changing our approach to the management of diminutive polyps is currently debated. Deemphasizing diminutive polyps and shifting our efforts to detection and complete removal of larger and higher-risk polyps deserves discussion and study. This article explores three controversies, and emerging concepts related to endoscopic polyp resection. First, we discuss challenges of optical resect-and-discard strategy and possible alternatives. Second, we review recent studies that support the use of cold snare resection for ≥5 mm polyps. Thirdly, we examine current evidence for prophylactic clipping after resection of large polyps.

Understanding optical reflectance contrast for real‐time characterization of epithelial precursor lesions

“…With the expanding implementation of colonoscopy for cancer screening, colorectal polyps are increasingly detected. 12 However, since more than 90% polyps are small with approximately 50% of them being nonneoplastic, 12,45,46 pathologic assessment is in most cases used only to determine surveillance intervals, 12,46 which give rise to significant healthcare costs. 12,47 Based on the understanding of reflectance contrasts established in this study, we show that pathology hallmarks like decreased goblet cells, pseudostratified nuclei and irregular crypt patterns in adenomatous polyps can be well recognized in μOCT images.…”

Kolorektales Karzinom: Rolle bildgebender Verfahren in der Vorsorge

“…Die systematische endoskopische Abtragung und histologische Aufarbeitung dieser sehr häufigen, jedoch klinisch nicht relevanten Veränderungen wäre nicht nur kostenintensiv, sondern würde auch das Komplikationsrisiko steigern. Sie wird auch in der endoskopischen Literatur teilweise kontrovers diskutiert [42].…”

Efficacy of small colon polyps (less than 10 mm) cold polypectomy methods at diagnostic colonoscopy in out-patient clinic

“…Результаты проведенных исследований показывают, что холодная полипэктомия позволяет снизить частоту осложнений, связанных с термическим воздействием на слизистую оболочку и подлежащие ткани [5]. Снижается не только число перфораций и проявлений посткоагуляционого синдрома [6], но и отсроченных кровотечений: 0% при удалении холодной петлей против 0,5-14% после классического удаления с применением электрического тока [7,8]. Немаловажно и то, что удаление полипов холодной петлей занимает меньше времени, чем горячей, составляя соответственно в среднем 18 мин против 25 мин [9].…”