Endoscopic Submucosal Dissection Versus Endoscopic Mucosal Resection of Large Colon Polyps: Use Both for the Best Outcomes

Editorials12 December 2023Endoscopic Submucosal Dissection Versus Endoscopic Mucosal Resection of Large Colon Polyps: Use Both for the Best OutcomesNicholas G. Burgess, MBChB, BSc, PhD, and Michael J. Bourke, MBBSNicholas G. Burgess, MBChB, BSc, PhDDepartment of Gastroenterology and Hepatology, Westmead Hospital, and Westmead Clinical School, University of Sydney School of Medicine, University of Sydney, Sydney, New South Wales, Australia, and Michael J. Bourke, MBBSDepartment of Gastroenterology and Hepatology, Westmead Hospital, and Westmead Clinical School, University of Sydney School of Medicine, University of Sydney, Sydney, New South Wales, AustraliaAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-3185 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Endoscopic resection has revolutionized the management of large (≥20 mm) nonpedunculated colorectal polyps (LNPCPs), all but removing the need for surgery. Guidelines strongly recommend expert endoscopic assessment of all LNPCPs before consideration of surgery (1, 2). Endoscopic mucosal resection (EMR) has driven this change. Adverse events (AEs) are infrequent and recurrence rates of 1% to 2% are achievable with margin ablation techniques (3). Widely adopted internationally, EMR is efficient, readily learned, and safe. Endoscopic submucosal dissection (ESD) is a more recent advance. The ability to resect lesions completely en bloc has benefits in terms of complete staging and potential cure ...References1. Kaltenbach T, Anderson JC, Burke CA, et al. Endoscopic removal of colorectal lesions-recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc. 2020;91:486-519. [PMID: 32067745] doi:10.1016/j.gie.2020.01.029 CrossrefMedlineGoogle Scholar2. Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2017;49:270-297. [PMID: 28212588] doi:10.1055/s-0043-102569 CrossrefMedlineGoogle Scholar3. Sidhu M, Shahidi N, Gupta S, et al. Outcomes of thermal ablation of the mucosal defect margin after endoscopic mucosal resection: a prospective, international, multicenter trial of 1000 large nonpedunculated colorectal polyps. Gastroenterology. 2021;161:163-170.e3. [PMID: 33798525] doi:10.1053/j.gastro.2021.03.044 CrossrefMedlineGoogle Scholar4. Jacques J, Schaefer M, Wallenhorst T, et al. Endoscopic en bloc versus piecemeal resection of large nonpedunculated colonic adenomas. A randomized comparative trial. Ann Intern Med. 2024;177:29-38. doi:10.7326/M23-1812 Google Scholar5. Tate DJ, Desomer L, Argenziano ME, et al. Treatment of adenoma recurrence after endoscopic mucosal resection. Gut. 2023;72:1875-1886. [PMID: 37414440] doi:10.1136/gutjnl-2023-330300 CrossrefMedlineGoogle Scholar6. Burgess NG, Hourigan LF, Zanati SA, et al. Risk stratification for covert invasive cancer among patients referred for colonic endoscopic mucosal resection: a large multicenter cohort. Gastroenterology. 2017;153:732-742.e1. [PMID: 28583826] doi:10.1053/j.gastro.2017.05.047 CrossrefMedlineGoogle Scholar7. van Hattem WA, Shahidi N, Vosko S, et al. Piecemeal cold snare polypectomy versus conventional endoscopic mucosal resection for large sessile serrated lesions: a retrospective comparison across two successive periods. Gut. 2021;70:1691-1697. [PMID: 33172927] doi:10.1136/gutjnl-2020-321753 CrossrefMedlineGoogle Scholar8. Cronin O, Sidhu M, Shahidi N, et al. Comparison of the morphology and histopathology of large nonpedunculated colorectal polyps in the rectum and colon: implications for endoscopic treatment. Gastrointest Endosc. 2022;96:118-124. [PMID: 35219724] doi:10.1016/j.gie.2022.02.022 CrossrefMedlineGoogle Scholar9. Ohata K, Kobayashi N, Sakai E, et al. Long-term outcomes after endoscopic submucosal dissection for large colorectal epithelial neoplasms: a prospective, multicenter, cohort trial from Japan. Gastroenterology. 2022;163:1423-1434.e2. [PMID: 35810779] doi:10.1053/j.gastro.2022.07.002 CrossrefMedlineGoogle Scholar10. Shahidi N, Vosko S, Gupta S, et al. A rectum-specific selective resection algorithm optimizes oncologic outcomes for large nonpedunculated rectal polyps. Clin Gastroenterol Hepatol. 2023;21:72-80.e2. [PMID: 35526795] doi:10.1016/j.cgh.2022.04.021 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Nicholas G. Burgess, MBChB, BSc, PhD; Michael J. Bourke, MBBSAffiliations: Department of Gastroenterology and Hepatology, Westmead Hospital, and Westmead Clinical School, University of Sydney School of Medicine, University of Sydney, Sydney, New South Wales, AustraliaDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-3185.Corresponding Author: Nicholas G. Burgess, MBChB, BSc, PhD, Department of Gastroenterology and Hepatology, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Westmead, Sydney, NSW 2145, Australia; e-mail, nicholas.burgess@sydney.edu.au.This article was published at Annals.org on 12 December 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEndoscopic En Bloc Versus Piecemeal Resection of Large Nonpedunculated Colonic Adenomas Jérémie Jacques , Marion Schaefer , Timothée Wallenhorst , Thomas Rösch , Vincent Lépilliez , Stanislas Chaussade , Jérôme Rivory , Romain Legros , Jean-Baptiste Chevaux , Sarah Leblanc , Florian Rostain , Maximilien Barret , Jérémie Albouys , Arthur Belle , Anaïs Labrunie , Pierre-Marie Preux , Hugo Lepetit , Martin Dahan , Thierry Ponchon , Sabrina Crépin , Loïc Marais , Julien Magne , and Mathieu Pioche Metrics Current IssueJanuary 2024Volume 177, Issue 1Page: 89-90KeywordsColorectal cancerEndoscopyGastroenterology and hepatologyPolypectomies ePublished: 12 December 2023 Issue Published: January 2024 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...