Guideline
Role of endoscopy in the staging and management of colorectal cancer

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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

  • We recommend removal of suspected neoplastic lesions at the time of colonoscopy when not contraindicated and as technical expertise allows. ⊕⊕⊕⊕

  • We recommend EUS in the preoperative locoregional staging of rectal cancer to guide therapy. ⊕⊕⊕○

  • 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. ⊕⊕⊕○

  • 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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    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.

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