The role of imaging and biopsy in the management and staging of large non-pedunculated rectal polyps.

The role of imaging and biopsy in the management and staging of large non-pedunculated rectal polyps. Expert Rev Gastroenterol Hepatol. 2018 Jun 25;: Authors: Banerjee AK, Longcroft-Wheaton G, Beable R, Conti J, Khan J, Bhandari P Abstract INTRODUCTION: Endoscopic Mucosal resection (EMR) and endoscopic submucosal dissection (ESD) is often used for benign and Sm1 large non-pedunculated rectal polyps (LNPRPs), although other surgical techniques including transanal endoscopic microsurgery (TEMS) and Transanal minimal invasive surgery (TAMIS) remain available. This review covers the role of pre- excisional imaging and selective biopsy of LNPRPs. Areas covered: Polyps between 2-3 cm with favourable features (Paris 1, Kudo III/IV pit patterns, non-- lateral spreading type (LST)) may have a one stage EMR without biopsy and imaging, provided adequate expertise is available with other technologies such as magnifying chromoendoscopy. Higher risk polyps (moderate/severe dysplasia, 0-IIa + c morphology, non-granular LST, Kudo pit pattern V, or submucosal carcinoma, or those >3 cm) should have pre EMR/ESD imaging with MRI (magnetic resonance imaging) and/or endorectal ultrasound (ERUS) +/- biopsies and photographs prior to multidisciplinary team (MDT) discussion. Expert commentary: In some centres EMR and ESD is considered the primary modality of treatment, with TEMS as a back-up, whilst elsewhere TEMS is the main modality for excision of SPEC...
Source: Expert Review of Gastroenterology and Hepatology - Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research