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Optimizing Resection of Large Colorectal Polyps.

Steven J Heitman1, David J Tate2,3, Michael J Bourke4,5

  • 1Department of Medicine, University of Calgary, Calgary, AB, Canada.

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|February 6, 2017
PubMed
Summary
This summary is machine-generated.

Endoscopic mucosal resection (EMR) effectively removes large colorectal polyps, reducing cancer risk. Advancements enhance EMR safety and efficacy, making it the preferred endoscopic treatment for lesions 20mm or larger.

Keywords:
Adverse eventsColorectal polypsEffectivenessEndoscopic mucosal resectionEndoscopic submucosal dissectionLaterally spreading lesionPolypectomy

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Area of Science:

  • Gastroenterology
  • Endoscopic Surgery
  • Oncology

Background:

  • Colorectal cancer (CRC) incidence and mortality are reduced by polypectomy.
  • Advancements in screening and endoscopic imaging increase detection of complex polyps, including large sessile or laterally spreading lesions (LSLs).
  • Endoscopic removal is now preferred over surgery for most large colorectal lesions.

Purpose of the Study:

  • To review the evidence supporting endoscopic mucosal resection (EMR) as the primary treatment for large colorectal LSLs (≥20 mm).
  • To highlight advancements in EMR techniques, safety, and management of complications.
  • To compare EMR with alternative endoscopic interventions like endoscopic submucosal dissection (ESD).

Main Methods:

  • Review of current literature and evidence supporting EMR for colorectal LSLs.
  • Discussion of advancements in EMR techniques, including managing recurrence, bleeding, and deep mural injury.
  • Comparison of EMR with endoscopic submucosal dissection (ESD) for complex colorectal lesions.

Main Results:

  • EMR is a highly effective and safe technique for treating colorectal LSLs when performed by trained endoscopists.
  • Advancements have improved understanding and management of post-EMR recurrence and intra-procedural complications.
  • ESD offers advantages for select lesions but is limited by complexity, risk, and cost.

Conclusions:

  • EMR is the established, first-line endoscopic treatment for colorectal LSLs ≥20 mm.
  • Continuous advancements are refining EMR's safety and effectiveness.
  • Expertise and meticulous technique are crucial for successful EMR outcomes.