Endoscopic resection of colorectal lesions: The narrowing divide between East and West (original) (raw)

Digestive Endoscopy, 2015

Abstract

Colonic polypectomy is an effective way of reducing colon cancer mortality. Multiple techniques now exist for the resection of polyps, and the endoscopist must decide on the appropriate resection approach for individual patients and lesions. This decision should maximize efficacy, safety and cost effectiveness and provide optimal oncological outcomes whilst minimizing unnecessary surgical treatment. Advances in endoscopic imaging technology are improving the accuracy of endoscopic diagnosis and allowing more precise risk assessment of colonic lesions. Resection technique can be tailored to the endoscopic findings. Diminutive (≤5 mm) and small polyps (≤9 mm) are best resected primarily by snare techniques. Cold snare polypectomy has proven safety, but efficacy and technique require further study. There is variation in techniques used for polyps 6-20 mm in size and incomplete resection rates for conventional polypectomy may be considerable. Endoscopic mucosal resection (EMR) is well established, safe and effective for lesions without submucosal invasion (SMI), however recurrence is a key limitation. Endoscopic submucosal dissection (ESD) is well established in the East, however it is resource intensive and its role in lesions with a low risk of SMI is questionable. ESD in the West remains incompletely defined and is associated with high adverse event rates, however it is becoming increasingly available and successful as experience grows. Emerging full thickness resection technologies are still in their infancy, and remain experimental due to the absence of reliable closure devices and techniques. Patient focused outcomes should guide technique selection. This article is protected by copyright. All rights reserved.

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