ASGE International Sampler (On-Demand) | 2024-Full Thickness Resection

Full Thickness Resection

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The document discusses the optimal management of malignant polyps. It outlines steps for recognizing the higher risk of cancer, determining the appropriate method of en bloc resection, preparing the resected lesion for pathology evaluation, and advising the patient on further treatment options. <br /><br />For pedunculated lesions, standard snare resection is recommended, with the clip site afterward. Non-pedunculated lesions up to 20 mm can be managed through standard EMR, tip-in EMR, underwater EMR, FTRD, or ESD. For non-pedunculated lesions up to 30 mm, underwater EMR or ESD is recommended. Non-pedunculated lesions over 30 mm should be resected using ESD.<br /><br />To optimize the resection, loops and clips should be used before transecting the lesion. Large pedunculated lesions should be resected low on the stalk. Small bulky lesions should be prepared by bivalving the pedunculated lesion or pinning the non-pedunculated lesion flat against a surface for optimal sectioning in pathology.<br /><br />The document also includes specific examples and techniques for en bloc resection methods such as underwater EMR, FTRD, and ESD. It emphasizes the importance of achieving complete resection without leaving any residual cancer in the bowel wall.<br /><br />Additionally, the document references a study conducted by Gibson et al, which examined the oncologic outcomes of piecemeal endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps with covert submucosal invasive cancer. The study found that a small percentage of cases had covert submucosal invasive cancer, and patients who underwent R1 resection had residual cancer in the bowel wall.<br /><br />In summary, the document provides guidance on the optimal management of malignant polyps, including recommendations for en bloc resection methods and the importance of thorough evaluation and complete resection to achieve the best oncologic outcomes.

Keywords

malignant polyps

cancer risk

en bloc resection

pathology evaluation

treatment options

standard EMR

underwater EMR

FTRD

ESD

oncologic outcomes