Journal Article

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

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

2020

Overview

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 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.4 The recent reductions in CRC incidence and mortality have been largely attributed to the widespread uptake of CRC screening with polypectomy.5 The techniques and outcomes of polyp removal using colonoscopy, however, had historically remained understudied and thus, practice widely varied. 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.7 Polypectomy techniques have expanded in parallel with advances in endoscopic imaging, technology, and tools. [...]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. Literature Review We performed a systematic review of the literature based on a defined search by a medical librarian of the Ovid Medline, Embase, and Cochrane databases from 1946 to December 2017, as well as reviews of manual references and scientific meeting abstracts of the American College of Gastroenterology, American Gastroenterology Association, American Society for Gastrointestinal Endoscopy, and United European Gastroenterology Week from 2014–2017.

• Publisher: Wolters Kluwer,Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subject: Adenoma - diagnostic imaging / Adenoma - pathology / Adenoma - surgery / Carcinoma - diagnostic imaging / Carcinoma - pathology / Carcinoma - surgery / Classification / Colonic Polyps - diagnostic imaging / Colonic Polyps - pathology / Colonic Polyps - surgery / Colonoscopy / Colonoscopy - methods / Colonoscopy - standards / Colorectal cancer / Colorectal Neoplasms - diagnostic imaging / Colorectal Neoplasms - pathology / Colorectal Neoplasms - surgery / Documentation / Early Detection of Cancer - methods / Early Detection of Cancer - standards / Endoscopy / Gastroenterology / Health surveillance / Histology / Humans / Lesions / Morphology / Mortality / Polyps / Task forces / Tumors