Mar 13, 2020, 14:03 PM

Colonoscopy with polypectomy reduces the incidence of and mortality from colorectal cancer (CRC). It is the cornerstone of effective prevention. 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 The lifetime risk to develop CRC in the United States is approximately 4.3%, with 90% of cases occurring after the age of 50 years. The recent reductions in CRC incidence and mortality have been largely attributed to the widespread uptake of CRC screening with polypectomy. The techniques and outcomes of polyp removal using colonoscopy, however, had historically remained understudied and thus, practice widely varied. Reports have shown that residual tissue after polypectomy that is judged to be “complete” by the endoscopist is common, ranging from 6.5% to 22.7%. The significant variation in incomplete resection rates among endoscopists has highlighted the dependence of polypectomy effectiveness on operator technique. A pooled analysis from 8 surveillance studies that followed participants with adenomas after a baseline colonoscopy suggested that although the majority (50%) of post-colonoscopy colon cancers were likely due to missed lesions, close to one-fifth of incident cancers were related to incomplete resection. Polypectomy techniques have expanded in parallel with advances in endoscopic imaging, technology, and tools. Optimal techniques encompass effectiveness, safety, and efficiency. Colorectal lesion characteristics, including location, size, morphology, and histology, influence the optimal removal method. For example, the applications of cold snare polypectomy for small lesions, which can remove adenomatous tissue en bloc with surrounding normal mucosa, and endoscopic mucosal resection (EMR) for large and flat lesions, which utilizes submucosal injection to lift the lesion before snare resection, have evolved to improve complete and safer resection. The primary aim of polypectomy is the complete and safe removal of the colorectal lesion and the ultimate prevention of CRC. This consensus statement provides recommendations to optimize complete and safe endoscopic removal techniques for colorectal lesions (Table 1), based on available literature and experience. The recommendations from the US Multi-Society Task force (USMSTF) on the management of malignant polyps, polyposis syndromes, and surveillance after colonoscopy and polypectomy are available in other documents. Table 2 summarizes abbreviations and definitions of terms utilized in these recommendations.

Tonya Kaltenbach, Joseph C. Anderson, Carol A. Burke, Jason A. Dominitz, Samir Gupta, David Lieberman, Douglas J. Robertson, Aasma Shaukat, Sapna Syngal, Douglas K. Rex

Title : Endoscopic Removal of Colorectal Lesions—Recommendations by the US Multi-Society Task Force on Colorectal Cancer

Doi org link : https://doi.org/10.1016/j.gie.2020.01.029

Volume : Gastrointest Endosc March 2020, Volume 91, Issue 3, Pages 486-519

URL :

Select a choice : Keep

Content created :

File size :

Number :

ExternalPK :

Categories :

Tags :

Load more comments