Recent advances in the management of large and complex colonic polyps

Longcroft‐Wheaton, Gaius; Bhandari, Megha; Alkandari, Asma; Bhandari, Pradeep

doi:10.12688/f1000research.12930.1

Cited by 3 publications

(11 citation statements)

References 35 publications

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“…Endoscopic mucosal resection (EMR) is a technique that involves the removal of lesions within the mucosa (71). EMR technique involves submucosal injection of a solution into submucosal space, thus lifting lesion away from the muscularis propria of the colon, followed by cautery snare resection (Figure 6) (12,73). Cold snare EMR is a widely used technique for polyps sized <10 mm, with emerging data that supports its use for polyps between 10 and 20 mm and even beyond 20 mm, specially for serrated lesions (Figure 7) (18,(74)(75)(76).…”

Section: Approach and Resection Techniques Endoscopic Mucosal Resectionmentioning

confidence: 99%

“…More than 90% of polyps detected during screening colonoscopies are small (<10 mm in size), mostly benign, and do not contain advanced disease. These can be easily managed by conventional cold forceps or by snare polypectomy (12,(16)(17)(18). Around 10-15% of colorectal polyps are considered "complex" as they are difficult to be appropriately removed with these conventional endoscopic methods due to their size, location, and morphology.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Most colorectal cancers arise from adenomatous polyps and sessile serrated lesions. Screening colonoscopy and therapeutic polypectomy can potentially reduce colorectal cancer burden by early detection and removal of these polyps, thus decreasing colorectal cancer incidence and mortality. Most endoscopists are skilled in detecting and removing the vast majority of polyps endoscopically during a routine colonoscopy. Polyps can be considered “complex” based on size, location, morphology, underlying scar tissue, which are not amenable to removal by conventional endoscopic polypectomy techniques. They are technically more challenging to resect and carry an increased risk of complications. Most of these polyps were used to be managed by surgical intervention in the past. Rapid advancement in endoscopic resection techniques has led to a decreasing role of surgery in managing these complex polyps. These endoscopic resection techniques do require an expert in the field and advanced equipment to perform the procedure. In this review, we discuss various advanced endoscopic techniques for the management of complex polyps.

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Section: Approach and Resection Techniques Endoscopic Mucosal Resectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…Several techniques such as endoscopic piecemeal mucosal resection (EPMR), endoscopic mucosal resection, endoscopic submucosal dissection (ESD), or hybrid ESD had developed in recent years. 10 Previous study had demonstrated a relatively higher recurrence rate of EPMR for large colorectal malignant polyps than benign polyps (33.3% vs 3.1%). 11 Saito et al also presented that EPMR resulted in a higher recurrence rate compared with ESD (14% vs 2%).…”

Section: Discussionmentioning

confidence: 88%

Incidence of interval colorectal cancer: A tertiary hospital report

Lai

Chiu

et al. 2020

Adv in Digestive Medicine

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Colorectal cancer (CRC) remains the leading cause of death in Taiwan despite mandatory CRC screening programs for early detection. The development of CRC between periods of follow-up remains a Taiwanese health and economic burden. This study aimed to investigate the relationship between consequent progression of polyps and interval CRC and identify potential risk factors. This retrospective chart review study reviewed 1671 CRC patients between 1 January 2002 and 31 December 2018, in Kaohsiung Chang Gung Memorial Hospital for interval CRC analysis. Interval CRC is defined as CRC diagnosed within 5 years after a negative colonoscopy. We further analyzed potential risk factors associated with interval CRC such as sex, age, underlying disease, and previous pathologic type of polyps by univariate and multivariate analyses. A total of 44 patients developed interval CRC in this study (2.63%). Ten patients were from the proctologist division and five from the gastroenterology department. Mean diagnostic interval was 919.45 ± 547.78 days in male and 897.87 ± 586.14 days in female patients. Multivariate analysis showed that right-side colon polyp demonstrated independent risk factors for interval CRC development in our observation (P < .001; hazard ratio (HR), 3.897; 95% confidence interval (CI), 1.934-7.780). In conclusion, interval CRC prevalence in a cohort is 2.63%. Location of polyps over the right colon is relevant to interval CRC occurrence.

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“…There were no significant differences in en bloc and curative resection rates between the two groups, probably due to the small sample size. training facilities, and higher risk of perforation [3,4]. To expedite dissection, hybrid ESD was introduced as a rescue treatment modality in difficult ESD cases [5].…”

Section: Methodsmentioning

confidence: 99%

“…Incision of three-quarters of the circumference with a Dual-Knife (Olympus America Inc., Center Valley, Pennsylvania, United States) to reach the submucosal plane of dissection was then performed to allow adequate retention of the submucosal injectate. The incision was performed using Endocut Q mode (3,3,3) of Erbe VIO 200 s generator (Erbe USA Marietta, Georgia, United States). After identification of the submucosal plane, repeated injection and dissection was performed using Swift Coag mode (Effect 3, watt: 35) followed by completing the circumferential incision to ensure resection of the lesion in one-piece fashion (en bloc resection method).…”

Section: Esd Proceduresmentioning

confidence: 99%

ESD with double-balloon endoluminal intervention platform versus standard ESD for management of colon polyps

et al. 2020

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Background and study aims Endoscopic submucosal dissection (ESD) with the double-balloon endoluminal intervention platform (DEIP) is a novel technique for removal of complex colon polyps (> 2 cm) or those located in anatomically difficult positions. DEIP helps create a therapeutic zone with improved visualization and stability, facilitating polyp removal. We aimed to compare the outcomes of DEIP with the conventional cap-assisted ESD (standard ESD) technique for colon polyp resection, in particular, the ability to complete the ESD procedure without resorting to hybrid ESD or piecemeal resection. Patients and methods This was a retrospective cohort of all patients who underwent colon ESD in a single large tertiary referral center between September 2016 and October 2019. Information was collected on patient demographics and study outcomes including procedure time, rates of en bloc and curative resection, operative and postoperative complications. All patients were followed up for 1 month after the procedure. Results 111 patients were included in the study (DEIP 60, standard ESD 51). There was no statistically significant difference between mean procedures time (± SD) in the two groups, mean (81.9 ± 35.4 min standard vs. 96.4 ± 42.2 min in DEIP). Mean polyp size (± SD) was similar between the two groups (7.6 ± 6.0 cm2 vs. 6.2 ± 5.5 cm2, P = .2). There were no significant differences in en bloc and curative resection rates or operative and postoperative complications between the two techniques. Conclusion Procedure time was similar using both techniques. However, DEIP enabled the entire procedure to be performed using the ESD technique without resorting to snare resection, which may affect the en bloc and curative resection rate. There were no significant differences in en bloc and curative resection rates between the two groups, probably due to the small sample size.

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Recent advances in the management of large and complex colonic polyps

Cited by 3 publications

References 35 publications

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

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

Incidence of interval colorectal cancer: A tertiary hospital report

ESD with double-balloon endoluminal intervention platform versus standard ESD for management of colon polyps

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