ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (Live and Virtual) | May 2023-Keswani_ Does the Data Determine Which Resection Method to Use 2023

Keswani_ Does the Data Determine Which Resection Method to Use 2023

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The document discusses the different methods of endoscopic resection (ER) for treating malignant colorectal polyps. The author emphasizes the importance of identifying malignancy in polyps before selecting the appropriate ER technique. The evidence shows that EMR is suitable for most colon polyps, while ESD is preferred for select cases. Cold EMR has shown success for serrated lesions but may not be the best choice for adenomatous lesions. Underwater EMR has comparable outcomes to conventional EMR with similar bleeding and perforation rates. Hybrid ESD, which involves a circumferential incision and possible dissection, has shown promising results compared to conventional EMR, with higher rates of en bloc resection and R0 resection. However, there is limited data available for hybrid ESD. The summary also provides potential questions for further exploration, comparing various ER techniques. The answer to selecting the appropriate technique depends on whether invasive malignancy is suspected or not, the presence of suspicious features, and the location of the polyp (colon or rectum). Overall, the document highlights the need for evidence-based decision-making in determining the most suitable ER method for malignant colorectal polyps.

Keywords

endoscopic resection

malignant colorectal polyps

identifying malignancy

ER techniques

EMR

ESD

cold EMR

adenomatous lesions

underwater EMR

hybrid ESD