ASGE Masterclass: Expert Performance Approach to Colonoscopy (Live/Virtual) | February 2026-Burning Questions and Wrap Up

Video Transcription

Video Summary

Experts discuss how to evaluate and manage suspicious colorectal lesions during colonoscopy, emphasizing careful optical diagnosis before resection. For non-granular lateral spreading tumors with pseudodepression or possible true depression, they recommend close inspection with NBI/magnification and sometimes dye spray to assess vascular and surface patterns for deep submucosal invasion. If cancer is strongly suspected, biopsy may be appropriate; otherwise, avoid biopsy when planning referral or later endoscopic resection because it can cause submucosal fibrosis and complicate removal. Management options include underwater EMR for suitable non-granular lesions and endoscopic full-thickness resection (EFTR), including “hybrid” approaches (EMR of benign portions plus EFTR of the depressed/cancer-suspicious focus). Surgery is reserved for lesions with features of deep invasion or high-risk cancer. For malignant polyps after en bloc EMR, they stress individualized decisions balancing low residual/lymph node risk against operative mortality, considering age/comorbidity and patient preferences.

Keywords

optical diagnosis

non-granular lateral spreading tumor

narrow-band imaging (NBI)

endoscopic full-thickness resection (EFTR)

deep submucosal invasion