TY - JOUR
T1 - How to deal with large colorectal polyps
T2 - Snare, endoscopic mucosal resection, and endoscopic submucosal dissection; Resect or refer?
AU - Thirumurthi, Selvi
AU - Raju, Gottumukkala S.
N1 - Publisher Copyright:
© 2015 Wolters Kluwer Health, Inc.
Copyright:
Copyright 2015 Elsevier B.V., All rights reserved.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - The importance of accurate polyp detection and removal is paramount to preventing colon cancer. Resection of large polyps can be challenging to the endoscopist based on their size, shape, or location. Large polyps have the potential of harboring malignancy and a higher risk of complications with resection. Careful assessment of each lesion and meticulous resection using the appropriate tools and techniques is essential. Recent findings Over the last 15 years, the development of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) techniques has presented the endoscopist with the opportunity to manage patients with large and flat lesions thereby avoiding the need for surgery. However, these techniques are complex and require extensive knowledge and skill in the use of various devices to resect a lesion completely and manage bleeding and perforation associated with these procedures. Summary Large colon polyps manifest as either polypoid or nonpolypoid (flat) lesions. Polypoid lesions, especially those with pedicles, are removed with snare resection, whereas flat lesions may require the use of EMR or ESD. Resection of large polyps (> 1 cm) requires additional tools and techniques to ensure safe and complete resection. We will discuss our approach to dealing with large colorectal polyps: snare, EMR, and ESD; resect or refer?
AB - The importance of accurate polyp detection and removal is paramount to preventing colon cancer. Resection of large polyps can be challenging to the endoscopist based on their size, shape, or location. Large polyps have the potential of harboring malignancy and a higher risk of complications with resection. Careful assessment of each lesion and meticulous resection using the appropriate tools and techniques is essential. Recent findings Over the last 15 years, the development of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) techniques has presented the endoscopist with the opportunity to manage patients with large and flat lesions thereby avoiding the need for surgery. However, these techniques are complex and require extensive knowledge and skill in the use of various devices to resect a lesion completely and manage bleeding and perforation associated with these procedures. Summary Large colon polyps manifest as either polypoid or nonpolypoid (flat) lesions. Polypoid lesions, especially those with pedicles, are removed with snare resection, whereas flat lesions may require the use of EMR or ESD. Resection of large polyps (> 1 cm) requires additional tools and techniques to ensure safe and complete resection. We will discuss our approach to dealing with large colorectal polyps: snare, EMR, and ESD; resect or refer?
KW - Endoscopic mucosal resection
KW - endoscopic submucosal dissection
KW - large polyp
KW - referral
KW - resection
UR - http://www.scopus.com/inward/record.url?scp=84950291266&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84950291266&partnerID=8YFLogxK
U2 - 10.1097/MOG.0000000000000228
DO - 10.1097/MOG.0000000000000228
M3 - Review article
C2 - 26627920
AN - SCOPUS:84950291266
SN - 0267-1379
VL - 32
JO - Current opinion in gastroenterology
JF - Current opinion in gastroenterology
IS - 1
ER -