GuidelineRole of endoscopy in the staging and management of colorectal cancer
Section snippets
Presurgical localization
Colonoscopy has an important role in the localization of malignant lesions for subsequent identification at the time of surgery. Preoperative endoscopic marking can be helpful in localizing flat, small, or subtle colonic lesions that may be difficult to identify by inspection or palpation during surgery. Marking techniques currently available include endoscopic tattooing and metallic clip placement.5, 6, 7 Tattoos with India ink are visible at surgery for up to 5 months.5 No guidelines exist on
Staging of rectal cancer
CRC is staged according to the TNM system established by the American Joint Committee on Cancer (Table 2).8 The primary clinical impact of staging rectal cancer is to differentiate T1N0 or T2N0 disease from T3 or TxN1-2 disease, for which chemoradiation is recommended in addition to surgical resection.9 Several meta-analyses have evaluated the staging accuracy of EUS,10, 11, 12, 13 and some have compared the accuracy of EUS with that of magnetic resonance imaging (MRI) and CT.10, 11 In general,
Endoscopic management of malignant colonic obstruction
Endoscopic management of malignant obstruction is discussed in a recent ASGE Standards of Practice document.26 Endoscopic alternatives to surgical decompression include placement of a self-expandable metal stent (SEMS), tumor debulking, and placement of a decompression tube. Even with successful endoscopic decompression, early surgical consultation is recommended because patients may deteriorate rapidly. Endoscopy should not be performed in patients with peritoneal signs or suspicion of
Endoscopic resection of colorectal neoplasia
In general, flat and polypoid lesions found at the time of colonoscopy should be removed.29 Pedunculated lesions are usually removed by using standard snare polypectomy. Pedunculated polyps with cancer confined to the submucosa and without evidence of unfavorable histological factors have a 0.3% risk of cancer recurrence or lymph node metastasis after complete endoscopic removal, and surgery is not necessary.30
For pedunculated polyps with unfavorable histological features (<1 mm cancer-free
Recommendations
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We recommend removal of suspected neoplastic lesions at the time of colonoscopy when not contraindicated and as technical expertise allows. ⊕⊕⊕⊕
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We recommend EUS in the preoperative locoregional staging of rectal cancer to guide therapy. ⊕⊕⊕○
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We recommend weighing the risk of recurrence against the individual's operative risk in all cases in which surgery is being considered as a treatment for CRC. ⊕⊕⊕○
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We recommend surgical management of all malignant polyps with unfavorable histological features
Disclosures
The following authors disclosed financial relationships relevant to this publication: Dr Fisher, consultant to Epigenomics Inc; Dr Hwang, on the speakers' bureau of Novartis, consultant to U.S. Endoscopy, and received a grant from Olympus; Dr Fanelli, owner/director of New Wave Surgical and on the advisory board of Via Surgical; Dr Khashab, consultant to, receives honoraria from, and on the advisory board of Boston Scientific; Dr Chathadi, on the speakers' bureau of Boston Scientific; Dr
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Cited by (53)
Impact of surgery after endoscopically resected high-risk T1 colorectal cancer: results of an emulated target trial
2024, Gastrointestinal EndoscopyNontunneling Full Thickness Techniques for Neoplasia
2023, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :T1 is further subclassified into T1a (invading <1000 μm) and T1b carcinomas (invading deeper than 1000 μm), where the latter is usually treated surgically due to higher risk of lymph node invasion. The current guidelines recommend endoscopic removal of suspected malignant lesions unless there is a deeper submucosal invasion or the lesion has high-risk histologic features for which they should be referred to surgery.3–5 High-risk features include poor differentiation, invasion into the deep submucosa or muscularis propria, and lymphovascular involvement.
Underwater vs Conventional Endoscopic Mucosal Resection of Large Sessile or Flat Colorectal Polyps: A Prospective Randomized Controlled Trial
2021, GastroenterologyCitation Excerpt :To our knowledge, this is the first randomized controlled clinical trial to compare the effectiveness and safety of UEMR with CEMR for large colorectal polyps between 20 and 40 mm in size. CEMR is well established and currently the treatment modality of choice for the resection of large colorectal polyps up to 20 mm in size.2,25–27 However, the major drawback of CEMR is its low rate of en bloc resection, especially for lesions >20 mm in size, because en bloc resection rates decrease with an increase in polyp size.28,29
Polypectomy Techniques
2020, Surgical Clinics of North AmericaCitation Excerpt :This finding makes it even more salient to clarify the proper procedural steps for polypectomy and reinforce the care that must be taken to prevent interval development of colorectal cancer. Overarching principles in endoscopic polypectomy include choosing the correct technique for the correct polyp, minimizing residual polyp by taking a small margin of surrounding normal mucosa, tissue ablation at resection margins, closer surveillance after piecemeal resection, and applying proper technique (see Table 2).22,24 The procedural steps of both CSP and HSP are discussed next.
Identification of salivary volatile organic compounds as potential markers of stomach and colorectal cancer: A pilot study
2020, Journal of Oral Biosciences
This article had an error in the print version (see the erratum in the September 2013 issue of GIE); the article posted here is the corrected version.
This document is a product of the Standards of Practice Committee. This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.