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World J Gastroenterol. Jan 21, 2019; 25(3): 300-307
Published online Jan 21, 2019. doi: 10.3748/wjg.v25.i3.300
Endoscopic resection techniques for colorectal neoplasia: Current developments
Franz Ludwig Dumoulin, Ralf Hildenbrand
Franz Ludwig Dumoulin, Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Bonn 53113, Germany
Ralf Hildenbrand, Institute for Pathology, Bonn Duisdorf, Bonn 53123, Germany
Author contributions: Both authors contributed equally to the paper. Both were involved in conception and literature review as well as in drafting including approval of the final submission of the manuscript.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Franz Ludwig Dumoulin, MD, PhD, Associate Professor, Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Bonner Talweg 4-6, Bonn 53113, Germany. f.dumoulin@gk-bonn.de
Telephone: +49-228-5081561 Fax: +49-228-5081562
Received: October 5, 2018
Peer-review started: October 5, 2018
First decision: November 7, 2018
Revised: November 30, 2018
Accepted: December 13, 2018
Article in press: December 13, 2018
Published online: January 21, 2019
Processing time: 110 Days and 11.7 Hours
Abstract

Endoscopic polypectomy and endoscopic mucosal resection (EMR) are the established treatment standards for colorectal polyps. Current research aims at the reduction of both complication and recurrence rates as well as on shortening procedure times. Cold snare resection is the emerging standard for the treatment of smaller (< 5mm) polyps and is possibly also suitable for the removal of non-cancerous polyps up to 9 mm. The method avoids thermal damage, has reduced procedure times and probably also a lower risk for delayed bleeding. On the other end of the treatment spectrum, endoscopic submucosal dissection (ESD) offers en bloc resection of larger flat or sessile lesions. The technique has obvious advantages in the treatment of high-grade dysplasia and early cancer. Due to its minimal recurrence rate, it may also be an alternative to fractionated EMR of larger flat or sessile lesions. However, ESD is technically demanding and burdened by longer procedure times and higher costs. It should therefore be restricted to lesions suspicious for high-grade dysplasia or early invasive cancer. The latest addition to endoscopic resection techniques is endoscopic full-thickness resection with specifically developed devices for flexible endoscopy. This method is very useful for the treatment of smaller difficult-to-resect lesions, e.g., recurrence with scar formation after previous endoscopic resections.

Keywords: Colorectal neoplasia; Colorectal cancer screening; Cold snare resection; Endoscopic polypectomy; Endoscopic mucosal resection; Endoscopic submucosal dissection; Endoscopic full-thickness resection; Adenoma recurrence rate

Core tip: Endoscopic polypectomy and endoscopic mucosal resection are the standard treatment options for colorectal neoplasia. Current research is evaluating cold snare resection for the treatment of smaller non-cancerous polyps, aiming to reduce procedure times and complication rates. Endoscopic submucosal dissection has great potential for the en bloc resection of larger flat or sessile lesions. However, it is technically demanding and time consuming and should be reserved for histologically advanced lesions. Endoscopic full-thickness resection is a welcome addition to the armamentarium of endoscopic resection techniques and is very useful for the treatment of smaller difficult-to-resect lesions.