Minimally invasive techniques combat precursors of colon cancer

Minimally invasive techniques combat precursors of colon cancer

Colorectal cancer (CRC) is the second most common cancer in the United States. This highlights the importance of early detection and treatment of precancerous lesions such as large polyps. Endoscopy offers a minimally invasive approach to removing these polyps, reducing the need for traditional surgical procedures.

This review, published ineGastroenterologyexamines advances in endoscopic resection techniques, particularly endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD).

Complete removal of large polyps (>10 mm) is crucial to prevent the progression of colorectal cancer. Piecemeal resection during endoscopic procedures may increase the risk of recurrence. EMR, the standard approach for large, nonpedunculated polyps, uses a submucosal injection to create a cushion that allows for a safer and more complete resection with a snare. ESD, a more advanced technique, is used for complex polyps with a higher risk of submucosal invasion. A precise incision is made and the polyp is separated from the underlying tissue layer by layer.

Both EMR and ESD offer advantages over surgery. They are less invasive, require shorter recovery times and are associated with fewer complications. However, the selection of the most appropriate technique depends on various factors, including polyp size, morphology, location and depth of submucosal invasion. EMR is generally preferred for simpler polyps, whereas ESD is indicated for those with features suggestive of deeper invasion.

ESD offers several advantages over EMR. This achieves higher en bloc resection rates (removal of the entire polyp in one piece), resulting in more accurate histological assessment and a lower risk of recurrence. However, ESD is a more complex and time-consuming procedure that requires hospitalization and carries a slightly higher risk of complications. Endoscopic expertise is paramount for successful ESD. Studies show that success rates improve significantly with increasing experience.

The choice between EMR and ESD should be made individually based on the patient's specific needs, polyp characteristics, and available expertise at the treatment center. In some cases, particularly in facilities with limited ESD experience or where delays due to complex procedures may outweigh the benefits, EMR may be the preferred approach.

In conclusion, EMR and ESD are valuable endoscopic techniques for the treatment of large colorectal polyps. Selecting the most appropriate procedure requires careful consideration of individual factors and the skills of the endoscopist. Ongoing research will refine these techniques and enable optimal treatment decisions for patients with precancerous colorectal lesions.

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