Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice

5_Draganov LST_in_the_Rectum

Pdf Summary

Dr. Peter Draganov, a professor of medicine at the University of Florida, discusses the management of laterally spreading rectal polyps (LSRs), focusing on endoscopic techniques to minimize unnecessary surgeries and improve outcomes. He highlights the importance of accurate diagnosis and treatment decisions for LSRs to prevent overtreatment, particularly with early-stage cancers like T1 colorectal cancer (CRC).<br /><br />It is emphasized that removing polyps en-bloc through Endoscopic Submucosal Dissection (ESD) can be beneficial compared to piecemeal removal via Endoscopic Mucosal Resection (EMR), which might necessitate subsequent surgeries. En-bloc resection allows for more precise histological evaluation, thus reducing the risk of unnecessary colectomies in cases of T1 CRC.<br /><br />The document describes several classification systems, such as the Paris Classification and morphological identifiers, to categorize and assess rectal lesions. Additionally, Draganov mentions the difficulties in distinguishing benign adenomas from lesions with submucosal invasion (SMI), stating that this remains a clinical challenge. Factors that predict covert SMI, such as lesion size and recto-sigmoid location, are discussed. He notes that rectal polyps are more likely to contain tubulovillous adenoma (TVA) histopathology and cancer relative to colonic polyps.<br /><br />Draganov suggests that ESD should be considered for rectal LSRs over 20 mm to ensure complete resection and recommends referring patients to centers skilled in advanced endoscopic techniques. The importance of avoiding certain practices, such as injecting tattoo ink at the lesion's base or initiating incomplete resections, is stressed to optimize patient outcomes.<br /><br />The overall goal is to efficiently treat dysplastic and early cancerous lesions with minimal invasiveness, thus enhancing patient management and avoiding unnecessary surgical interventions.

Keywords

laterally spreading rectal polyps

endoscopic techniques

Endoscopic Submucosal Dissection

Endoscopic Mucosal Resection

T1 colorectal cancer

Paris Classification

submucosal invasion

tubulovillous adenoma

advanced endoscopic techniques

minimally invasive treatment