Minireviews
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 21, 2013; 19(27): 4277-4288
Published online Jul 21, 2013. doi: 10.3748/wjg.v19.i27.4277
Endoscopy and polyps-diagnostic and therapeutic advances in management
Scott R Steele, Eric K Johnson, Bradley Champagne, Brad Davis, Sang Lee, David Rivadeneira, Howard Ross, Dana A Hayden, Justin A Maykel
Scott R Steele, Eric K Johnson, Department of Surgery, Madigan Army Medical Center, Madigan Health System, Tacoma, WA 98431, United States
Bradley Champagne, Division of Colon and Rectal Surgery, Case Western Reserve Medical Center, Cleveland, OH 44106, United States
Brad Davis, Department of Surgery, University of Cincinnati, Cincinnati, OH 45267, United States
Sang Lee, Division of Colon and Rectal Surgery, Weill Cornell Medical College, New York, NY 10065, United States
David Rivadeneira, Department of Surgery, Huntington Hospital/North Shore-LIJ Health System, Huntington, NY 11743, United States
Howard Ross, Department of Surgery, Riverview Plaza Riverview Medical Center, Red Bank, NJ 07701, United States
Dana A Hayden, Department of Surgery, Loyola University Health System, Chicago, IL 60660, United States
Justin A Maykel, Division of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA 01609, United States
Author contributions: Steele SR contributed to conception and design, and drafting of manuscript; Steele SR and Johnson EK contributed to acquisition of data; Steele SR, Johnson EK, Champagne B, Davis B and Maykel JA contributed to analysis and interpretation of data; Johnson EK, Champagne B, Davis B, Lee S, Rivadeneira D, Ross H, Hayden DA and Maykel JA contributed to critical revision; Steele SR and Maykel JA contributed to supervision.
Correspondence to: Scott R Steele, MD, FACS, Chief, Department of Surgery, Madigan Army Medical Center, Madigan Health System, JBLM, 9040a Fitzsimmons Drive, Tacoma, WA 98431, United States. harkersteele@mac.com
Telephone: +1-253-9682200 Fax: +1-253-9685900
Received: April 27, 2013
Revised: June 6, 2013
Accepted: June 8, 2013
Published online: July 21, 2013
Processing time: 84 Days and 15.1 Hours
Abstract

Despite multiple efforts aimed at early detection through screening, colon cancer remains the third leading cause of cancer-related deaths in the United States, with an estimated 51000 deaths during 2013 alone. The goal remains to identify and remove benign neoplastic polyps prior to becoming invasive cancers. Polypoid lesions of the colon vary widely from hyperplastic, hamartomatous and inflammatory to neoplastic adenomatous growths. Although these lesions are all benign, they are common, with up to one-quarter of patients over 60 years old will develop pre-malignant adenomatous polyps. Colonoscopy is the most effective screening tool to detect polyps and colon cancer, although several studies have demonstrated missed polyp rates from 6%-29%, largely due to variations in polyp size. This number can be as high as 40%, even with advanced (> 1 cm) adenomas. Other factors including sub-optimal bowel preparation, experience of the endoscopist, and patient anatomical variations all affect the detection rate. Additional challenges in decision-making exist when dealing with more advanced, and typically larger, polyps that have traditionally required formal resection. In this brief review, we will explore the recent advances in polyp detection and therapeutic options.

Keywords: Polyps; Endoscopy; Colonoscopy; Endoscopic submucosal dissection; Endoscopic mucosal resection; Quality; Combined endoscopic-laparoscopic resection; Combined laparoscopic-endoscopic resection; Combined endoscopic-laparoscopic surgery

Core tip: Changes in polyp detection including chromoendoscopy and narrow band imaging, as well as reliance on quality indicators such as the 6-min withdrawal time, aim to improve adenoma detection rates. Once identified, novel approaches for large and advanced polyps such as endoscopic submucosal dissection and endoscopic mucosal resection, combined laparoscopic-endoscopic resection along with combined endoscopic-laparoscopic resection are available to surgeons that may obviate the need for formal resection. Although technical expertise and experience is required, physicians caring for these patients should be familiar with each of these alternative procedures.