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Endoscopic management of difficult laterally spreading tumors in colorectum

Due to the advent of the screening programs for colorectal cancer and the era of quality assurance colonoscopy the number the polyps that can be considered difficult, including large (> 20 mm) laterally spreading tumors (LSTs), has increased in the last decade. All LSTs should be assessed careful...

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Autores principales: Castillo-Regalado, Edgar, Uchima, Hugo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8984535/
https://www.ncbi.nlm.nih.gov/pubmed/35432746
http://dx.doi.org/10.4253/wjge.v14.i3.113
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author Castillo-Regalado, Edgar
Uchima, Hugo
author_facet Castillo-Regalado, Edgar
Uchima, Hugo
author_sort Castillo-Regalado, Edgar
collection PubMed
description Due to the advent of the screening programs for colorectal cancer and the era of quality assurance colonoscopy the number the polyps that can be considered difficult, including large (> 20 mm) laterally spreading tumors (LSTs), has increased in the last decade. All LSTs should be assessed carefully, looking for suspicious areas of submucosal invasion (SMI), such as nodules or depressed areas, describing the morphology according to the Paris classification, the pit pattern, and vascular pattern. The simplest, most appropriate and safest endoscopic treatment with curative intent should be selected. For LST-granular homogeneous type, piecemeal endoscopic mucosal resection should be the first option due to its biological low risk of SMI. LST-nongranular pseudodepressed type has an increased risk of SMI, and en bloc resection should be mandatory. Underwater endoscopic mucosal resection is useful in situations where submucosal injection alters the operative field, e.g., for the resection of scar lesions, with no lifting, adjacent tattoo, incomplete resection attempts, lesions into a colonic diverticulum, in ileocecal valve and lesions with intra-appendicular involvement. Endoscopic full thickness resection is very useful for the treatment of difficult to resect lesions of less than 20 up to 25 mm. Among the indications, we highlight the treatment of polyps with suspected malignancy because the acquired tissue allows an exact histologic risk stratification to assign patients individually to the best treatment and avoid surgery for low-risk lesions. Endoscopic submucosal dissection is the only endoscopic procedure that allows completes en bloc resection regardless of the size of the lesion. It should therefore be indicated in the treatment of lesions with risk of SMI.
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spelling pubmed-89845352022-04-15 Endoscopic management of difficult laterally spreading tumors in colorectum Castillo-Regalado, Edgar Uchima, Hugo World J Gastrointest Endosc Minireviews Due to the advent of the screening programs for colorectal cancer and the era of quality assurance colonoscopy the number the polyps that can be considered difficult, including large (> 20 mm) laterally spreading tumors (LSTs), has increased in the last decade. All LSTs should be assessed carefully, looking for suspicious areas of submucosal invasion (SMI), such as nodules or depressed areas, describing the morphology according to the Paris classification, the pit pattern, and vascular pattern. The simplest, most appropriate and safest endoscopic treatment with curative intent should be selected. For LST-granular homogeneous type, piecemeal endoscopic mucosal resection should be the first option due to its biological low risk of SMI. LST-nongranular pseudodepressed type has an increased risk of SMI, and en bloc resection should be mandatory. Underwater endoscopic mucosal resection is useful in situations where submucosal injection alters the operative field, e.g., for the resection of scar lesions, with no lifting, adjacent tattoo, incomplete resection attempts, lesions into a colonic diverticulum, in ileocecal valve and lesions with intra-appendicular involvement. Endoscopic full thickness resection is very useful for the treatment of difficult to resect lesions of less than 20 up to 25 mm. Among the indications, we highlight the treatment of polyps with suspected malignancy because the acquired tissue allows an exact histologic risk stratification to assign patients individually to the best treatment and avoid surgery for low-risk lesions. Endoscopic submucosal dissection is the only endoscopic procedure that allows completes en bloc resection regardless of the size of the lesion. It should therefore be indicated in the treatment of lesions with risk of SMI. Baishideng Publishing Group Inc 2022-03-16 2022-03-16 /pmc/articles/PMC8984535/ /pubmed/35432746 http://dx.doi.org/10.4253/wjge.v14.i3.113 Text en ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article 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 NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
spellingShingle Minireviews
Castillo-Regalado, Edgar
Uchima, Hugo
Endoscopic management of difficult laterally spreading tumors in colorectum
title Endoscopic management of difficult laterally spreading tumors in colorectum
title_full Endoscopic management of difficult laterally spreading tumors in colorectum
title_fullStr Endoscopic management of difficult laterally spreading tumors in colorectum
title_full_unstemmed Endoscopic management of difficult laterally spreading tumors in colorectum
title_short Endoscopic management of difficult laterally spreading tumors in colorectum
title_sort endoscopic management of difficult laterally spreading tumors in colorectum
topic Minireviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8984535/
https://www.ncbi.nlm.nih.gov/pubmed/35432746
http://dx.doi.org/10.4253/wjge.v14.i3.113
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