Endoluminal Approaches to Complex Colorectal Polypoid Lesion
A rebroadcast of an important topic and discussion from a panel of experts who will discuss management of complex colorectal polyps. Although there are no hard-and-fast rules, endoscopic mucosal resection (EMR) of complex colorectal polyps is appropriate for mucosal polyps of any size and for superficial T1a colorectal cancer with a diameter <2cm (limited invasion into the submucosal layer, lack of lymphovascular invasion). In patients who present with evidence of deep invasion, demonstrated by induration, ulceration, and the non-lifting sign with submucosal injection, an alternative approach should be considered. Traditionally, rectal lesions deemed endoscopically unresectable required a segmental oncologic resection, with either an abdominoperineal or a low anterior resection; both procedures carry a significant risk of perioperative adverse events. More recent alternatives for management of complex colorectal polyps include endoscopic submucosal dissection (ESD), endoscopic full-thickness resection (EFTR) and transanal endoscopic surgery for select early (T1) rectal cancers.