Optimal Endoscopic Treatment and Surveillance of Serrated Polyps.
Optimal Endoscopic Treatment and Surveillance of Serrated Polyps. Gut Liver. 2019 Oct 08;: Authors: Gupta V, East JE Abstract Serrated polyps are considered precursor lesions that account for 15% to 30% of colorectal cancers, and they are overrepresented as a cause of interval cancers. They are difficult to detect and resect comprehensively; however, recent data suggest that high definition endoscopy, chromoendoscopy (via spray catheter, pump or orally), narrow band imaging, split-dose bowel preparation and a slower withdrawal (>6 minutes) can all improve detection. Cold snare resection is effective and safe for these lesions, including cold snare piecemeal endoscopic mucosal resection, which is likely to become the standard of care for lesions>10 mm in size. Sessile serrated lesions ≥10 mm in size, those exhbiting dysplasia, or traditional serrated adenomas increase the chance of future advanced neoplasia. Thus, a consensus is emerging: a surveillance examination at 3 years should be recommended if these lesions are detected. Serrated lesions likely carry equivalent risk to adenomas, so future guidelines may consider serrated class lesions and adenomas together for risk stratification. Patients with serrated polyposis syndrome should undergo surveillance every 1 to 2 years once the colon is cleared of larger lesions, and their first degree relatives should undergo screening every 5 years starting at age 40. PMID: 31581390 [PubMed - as suppli...
ConclusionThe fusion fascia of Fredet is useful to achieve CME and D3-L in right colon cancers with reduced risk of intraoperative complications. This structure is particularly suitable for minimally invasive surgery; therefore, we encourage awareness of the fascia of Fredet by colorectal surgeons.
Conclusions: Solitary PJPs did not recur in this study. Although examination of the entire gastrointestinal tract using esophagogastroduodenoscopy, enteroscopy, and colonoscopy is desirable to exclude Peutz-Jeghers syndrome, follow-up endoscopy after endoscopic polyp resection may be unnecessary, once the diagnosis of a solitary PJP is made. PMID: 31582972 [PubMed]
CONCLUSIONS: This study demonstrates that cancer-negative forceps biopsies of large colorectal polyps, referred for endoscopic resection, are not reliable. Considering that endoscopic resection of lesions containing superficial cancer is plausible, the clinical value of forceps biopsies in lesions suitable for endoscopic resection is questionable. See Video Abstract at http://links.lww.com/DCR/A984. LAS BIOPSIAS CON FÓRCEPS NO SON CONFIABLES EN EL ESTUDIO DE LAS LESIONES COLORRECTALES GRANDES REFERIDAS PARA RESECCIÓN ENDOSCÓPICA: ¿DEBERÍAN ABANDONARSE? ANTECEDENTES: Las biopsias se ...
ConclusionsOur results suggest that there is not a strong association between SSA/Ps and subsequent advanced colorectal neoplasia during the 5 years following SSA/P removal.
Once it became clear that most colorectal cancers developed from premalignant colon polyps, screening colonoscopy with removal of these polyps became the focus of colon cancer prevention with demonstrable effectiveness. The brilliant simplicity of the flexible cautery snare quickly became the standard method for polypectomy, and the use of partial colon resections to remove precancerous colon polyps plummeted. As colonoscopy evolved with an emphasis on higher detection of adenomas and identification of subtle flat colon lesions such as sessile serrated adenomas, the need for improved polypectomy techniques has become obvious.
A key to successful colorectal cancer (CRC) prevention is complete colon polyp removal. The quality of colonoscopy is currently defined by how well we identify neoplastic lesions, as measured by adenoma detection rates (ADRs). A higher ADR correlates with lower rates of interval colon cancers.1 However, the completeness and skills of resection are important factors as well, but they are not current quality metrics and would be an onerous task to measure in daily practice.
ConclusionColon polyps are incompletely resected in a small but potentially significant percentage of cases. IRR are similar with the use of cold jumbo forceps and cold snare. Use of cold jumbo forceps may result in more successful tissue retrieval as compared to cold snare.
With more colorectal cancer screening&large polyp removal, delayed post-polypectomy ulcer bleeds (PPUB) are increasing. Risk factors are right colon, sessile configuration, EMR removal, bleeding during polypectomy,&resumption of anti-coagulants&/or dual anti-platelet drugs. Prophylactic clip closure of PPU ’s is reported to be safe but does not reduce delayed PPUB nor is it cost effective. In our studies of patients hospitalized with delayed PPUB, all had ulcers, most with stigmata&arterial blood flow detected by Doppler endoscopic probe (DEP).
This study seeks to explore the relationship between an endoscopist ’s ADR and the total number of right versus left colon polyps removed per procedure per endoscopist.
Incomplete resection of colorectal neoplasia decreases the efficacy of colonoscopy and contributes to post-colonoscopy colorectal cancer. Conventional endoscopic resection (CR) of polyps, performed in a gas-distended colon, is the current standard, but incomplete resection rates (IRR) of approximately 3-25% for non-diminutive (>5mm) non-pedunculated lesions are reported. Underwater endoscopic resection (UR), a novel technique utilizing advantages of water-aided colonoscopy, may help reduce IRR.