British Society of Gastroenterology position statement on serrated polyps in the colon and rectum
Serrated polyps have been recognised in the last decade as important premalignant lesions accounting for between 15% and 30% of colorectal cancers. There is therefore a clinical need for guidance on how to manage these lesions; however, the evidence base is limited. A working group was commission by the British Society of Gastroenterology (BSG) Endoscopy section to review the available evidence and develop a position statement to provide clinical guidance until the evidence becomes available to support a formal guideline. The scope of the position statement was wide-ranging and included: evidence that serrated lesions have premalignant potential; detection and resection of serrated lesions; surveillance strategies after detection of serrated lesions; special situations—serrated polyposis syndrome (including surgery) and serrated lesions in colitis; education, audit and benchmarks and research questions. Statements on these issues were proposed where the evidence was deemed sufficient, and re-evaluated modified via a Delphi process until>80% agreement was reached. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool was used to assess the strength of evidence and strength of recommendation for finalised statements. Key recommendation: we suggest that until further evidence on the efficacy or otherwise of surveillance are published, patients with sessile serrated lesions (SSLs) that appear associated with a higher risk of future neoplasi...
Conclusion Incomplete polyp resection was frequent after polypectomy in routine clinical practice. Serrated histology and proximal location were independent risk factors for incomplete resection. The performance of board-certified gastroenterologists was not superior to that of trainees. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, GermanyArticle in Thieme eJournals: Table of contents | Abstract | Full text
Colonoscopic removal of adenomatous polyps has a preventive effect for colorectal cancer. Cold snare polypectomy is an effective method of polyp removal for small polyps (5 mm to 10 mm). Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is used for larger polyps (>10 mm). Submucosal injection during EMR or ESD is helpful to prevent complications. However, the effect of submucosal injection in cold snare polypectomy for small polyps is not clear. The aim of this study is to evaluate the risks of bleeding in cold snare polypectomy for small polyps and to investigate the effect of submucosal injection.
Postpolypectomy bleeding and incomplete polyp removal are important complication and quality concerns of colonoscopy for colon cancer prevention. Endoscopic mucosal stripping (EMS) is a modified extension of traditional cold snare polypectomy to avoid submucosal injury during removal of non-pedunculated colon polyps. We previously demonstrated EMS could potentially eliminate postpolypectomy bleeding, especially for advanced colon polyps, and facilitate complete polyp removal based on polypectomy site biopsy and short-term follow-up colonoscopy (1,2).
We reported retrospective data that compared with CO2 insufflation, water exchange (WE) colonoscopy significantly reduced rAMR (17.5% vs. 33.8%, P=0.034) (BMC Gastroenterol 2019;19:143). We performed a prospective randomized controlled trial (RCT) of WE and CO2 insufflation to determine whether WE with near-complete removal of infused water during insertion could reduce rAMR and rAMR combined with right colon hyperplastic polyp miss rate (rHPMR).
Endoscopic submucosal dissection (ESD) allows en bloc removal of colon polyps and early colon cancer. Multiple studies have demonstrated the advantages of ESD versus endoscopic mucosal resection (EMR). However, ESD is technically difficult, labor-intensive and time-consuming. We performed a single center, retrospective observational study to evaluate safety and effectiveness of a new endoluminal double balloon interventional platform (Lumendi LLC, Westport, CT) for colonic polyp resection.
Colonoscopy is considered to be the preferred modality for colo-rectal cancer (CRC) screening because it has both diagnostic and therapeutic capabilities. Current consensus dictates that colonoscopy be performed with rapid passage of the instrument through the loops and bends of the colon to the cecum. The time taken for this is called cecal intubation time (CIT). This is then followed by thorough evaluation for and removal of all polyps during a slow deliberate withdrawal, the time taken for which is called withdrawal time.
Conclusion CSP is underutilized for small polyp resection despite its favorable safety and efficacy. Benign polyps are commonly referred for surgery and overt SMIC is underappreciated using endoscopic imaging. Addressing these issues may reduce diathermy-related adverse events, surgery, and unnecessary colonoscopic procedures for patients and reduce rates of post-colonoscopy colorectal cancer. [...] © Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abstract | open access Full text
A 71-year-old woman with a family history of colon cancer underwent a surveillance colonoscopy, which revealed a 12-mm Paris IIb polyp involving the appendiceal orifice (A). Endoscopic full-thickness resection (EFTR) was performed by use of the Ovesco full-thickness resection device (FTRD, Ovesco Endoscopy, Tubingen, Germany). The lesion was pulled into the cap with a grasping forceps, the clip was deployed, and the resection was performed. The patient tolerated the procedure well and was discharged home.
Conclusion Indigo carmine chromoendoscopy improves early detection of residual disease post polypectomy, reducing incomplete resection rates. [...] © Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abstract | open access Full text
AbstractPurposeTo determine if there is an association between diverticular disease and colon cancer diagnoses with a secondary outcome of assessing other known risk factors for colon cancer. Colon cancer and diverticular disease have many shared symptoms and risk factors; the association between the two has been debated for many years.Methods36 cases of colon cancer and 144 age- and sex-matched controls were identified from records at an outpatient endoscopy center in Georgia. These cases and controls then were subject to a retrospective chart review to obtain any known risk factor data points for both diverticular diseas...