Principles for Evaluation of Surveillance after Removal of Colorectal Polyps: Recommendations from the World Endoscopy Organization
Colorectal polyps such as adenomas and serrated polyps are precursors for colorectal cancer (CRC). Therefore, removal of such polyps reduces CRC risk.1 Patients who had adenomas or serrated polyps removed at colonoscopy are believed to be at increased risk of developing more polyps later in life and eventually CRC.2,3 Thus, colonoscopy surveillance after polyp removal is currently recommended.4
ConclusionOur results suggest thatBRAF-mutant and CIMP-high serrated polyps are not associated with subsequent advanced colorectal neoplasia. Among SSA/Ps,MLH1 methylation may be an important marker to identify high-risk CRC precursors.
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).
Incomplete resection of neoplastic colorectal polyps can cause of post-colonoscopy colorectal cancer. This systematic review and meta-analysis aimed to determine the incomplete resection rate (IRR) of colorectal polyps and associated factors.
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
Colonoscopy with polypectomy reduces the incidence of and mortality from colorectal cancer (CRC).1,2 It is the cornerstone of effective prevention.3 The National Polyp Study showed that removal of adenomas during colonoscopy is associated with a reduction in CRC mortality by up to 50% relative to population controls.1,2
Colonoscopy is performed routinely for colorectal cancer (CRC) screening, follow-up of other abnormal screening tests, workup of signs and symptoms of gastrointestinal disease, and surveillance after CRC and polyp removal. Post procedure, colonoscopists are expected to provide follow-up recommendations to patients and referring physicians. Recommendations for follow-up after normal colonoscopy among individuals age-eligible for screening, and post-polypectomy among all individuals with polyps are among the most common clinical scenarios requiring guidance.
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.
A 70-year-old woman underwent colonoscopy because of a positive result from a fecal occult blood test and a family history of colorectal cancer. Her comorbidities were osteoporosis and an appendectomy 40 years earlier. A 15-mm flat polyp (type 0-IIa) was noted at the appendiceal orifice (A). Biopsy specimens showed tubular adenoma with low-grade dysplasia. Because of the position of the adenoma, endoscopic full-thickness resection (ETFR) was undertaken with a full-thickness resection device (FTRD, Ovesco Endoscopy, Tubingen, Germany) with the use of mechanical traction and additional suction (B).