Standardization of endoscopic resection for colorectal tumors larger than 10 mm in diameter

Abstract

Currently, several endoscopic resection (ER) methods for colorectal tumors are available, including polypectomy, conventional endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and modified ER. In the present review, we mainly focus on the current status of ER for colorectal tumors as well as the report from the Endoscopic Forum Japan (EFJ) 2016, which was held in Tokyo in August 2016. The proposed ER methods for colorectal tumors larger than 10 mm in diameter are as follows. (i) Pedunculated-type tumor is an indication for polypectomy, regardless of size. (ii) Non-pedunculated-type tumor larger than 20 mm in diameter is an indication for ESD in which en bloc resection using conventional EMR is difficult or impossible. (iii) Non-pedunculated-type tumor from 10 mm to 20 mm in diameter is an indication for conventional EMR. However, ESD or modified ER methods are acceptable according to the procedure and the condition of the tumor.

Prevention and management of spouting bleeding during endoscopic submucosal dissection for large subpedunculated‐type colonic tumor

“…Endoscopic submucosal dissection (ESD) is a reliable method for treating superficial colorectal tumors; however, it is technically more difficult and requires more experience than gastric ESD, because of difficulties associated with endoscope operability and the anatomical features of the colorectal region, including the presence of folds/flexures, bending of the intestinal tract, and the thinness of the intestinal wall . Main accidental complications during colorectal ESD are perforation and bleeding . With continued bleeding, visibility of the operative field deteriorates.…”

Peristaltic contractions help snaring during underwater endoscopic mucosal resection of colonic non‐granular pseudodepressed laterally spreading tumor

“…BRIEF EXPLANATION E N BLOC RESECTION of laterally spreading tumors (LST)-non granular (NG) pseudodepressed type is mandatory due to a high risk of submucosal invasion. 1,2 Sometimes, it might be difficult to snare these lesions.…”