Advertisement

Endoscopic Management of Polyps, Polypectomy, and Combined Endoscopic and Laparoscopic Surgery

  • Kelly A. Garrett
  • Sang W. LeeEmail author
Chapter

Abstract

Polypectomy is fundamental to the practice of colonoscopy. Polypectomy disrupts the adenoma to carcinoma sequence, thereby reducing colorectal cancer incidence and mortality. The goals of polypectomy are the effective, safe, and efficient removal of precancerous polyps while minimizing the risk of complications. Recent advances in endoscopic techniques such as endoscopic mucosal resection and endoscopic submucosal dissection can ensure complete and safe resection of lesions and evade surgery in some patients. Combined endo-laparoscopic surgery is an adjunct to endoscopic polypectomy that may help to avoid colectomy. Although polyp removal using these advanced techniques may be an effective alternative in select patients, they require both experience and expertise to become an available option in a surgeon’s armamentarium.

Keywords

Colon polyp Adenoma Colonoscopy Polypectomy Colon biopsy Adenoma Endoscopic mucosal resection Endoscopic submucosal dissection Combined endoscopic laparoscopic surgery 

Supplementary material

Video 5.1

Combined endoscopic-laparoscopic surgery for removal of a polyp. Courtesy of Sang Lee, MD (MP4 331763 kb) (M4V 331763 kb)

References

  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29.CrossRefGoogle Scholar
  2. 2.
    Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116(3):544–73.CrossRefGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention. National Center for Health Statistics. National heath interview surveys 2000, 2013. public use data files. Updated 2014.Google Scholar
  4. 4.
    Zauber AG, Winawer SJ, O’Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366(8):687–96.CrossRefGoogle Scholar
  5. 5.
    Baker SL, Miller RA, Creighton A, Aguilar PS. Effect of 6-minute colonoscopy withdrawal time policy on polyp detection rate in a community hospital. Gastroenterol Nurs. 2015;38(2):96–9.CrossRefGoogle Scholar
  6. 6.
    Baxter NN, Sutradhar R, Forbes SS, Paszat LF, Saskin R, Rabeneck L. Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer. Gastroenterology. 2011;140(1):65–72.CrossRefGoogle Scholar
  7. 7.
    Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. veterans affairs cooperative study group 380. N Engl J Med. 2000;343(3):162–8.CrossRefGoogle Scholar
  8. 8.
    Rathgaber SW, Wick TM. Colonoscopy completion and complication rates in a community gastroenterology practice. Gastrointest Endosc. 2006;64(4):556–62.CrossRefGoogle Scholar
  9. 9.
    Rex DK, Bond JH, Winawer S, et al. Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. multi-society task force on colorectal cancer. Am J Gastroenterol. 2002;97(6):1296–308.CrossRefGoogle Scholar
  10. 10.
    Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006;355(24):2533–41.CrossRefGoogle Scholar
  11. 11.
    Corley DA, Jensen CD, Marks AR, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014;370(14):1298–306.CrossRefGoogle Scholar
  12. 12.
    Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015;81(1):31–53.CrossRefGoogle Scholar
  13. 13.
    Chapuis PH, Dent OF, Goulston KJ. Clinical accuracy in the diagnosis of small polyps using the flexible fiberoptic sigmoidoscope. Dis Colon Rectum. 1982;25(7):669–72.CrossRefGoogle Scholar
  14. 14.
    Neale AV, Demers RY, Budev H, Scott RO. Physician accuracy in diagnosing colorectal polyps. Dis Colon Rectum. 1987;30(4):247–50.CrossRefGoogle Scholar
  15. 15.
    Bujanda L, Cosme A, Gil I, Arenas-Mirave JI. Malignant colorectal polyps. World J Gastroenterol. 2010;16(25):3103–11.CrossRefGoogle Scholar
  16. 16.
    Molatore S, Ranzani GN. Genetics of colorectal polyps. Tech Coloproctol. 2004;8 Suppl 2:s240–2.CrossRefGoogle Scholar
  17. 17.
    Gschwantler M, Kriwanek S, Langner E, et al. High-grade dysplasia and invasive carcinoma in colorectal adenomas: a multivariate analysis of the impact of adenoma and patient characteristics. Eur J Gastroenterol Hepatol. 2002;14(2):183–8.CrossRefGoogle Scholar
  18. 18.
    Kulling D, Christ AD, Karaaslan N, Fried M, Bauerfeind P. Is histological investigation of polyps always necessary? Endoscopy. 2001;33(5):428–32.CrossRefGoogle Scholar
  19. 19.
    Church J. Polyp treatment. In: Endoscopy of the colon, rectum and anus. 1st ed. Japan: Igaku-Shoin; 1995. p. 156–78.Google Scholar
  20. 20.
    Lee SW, Garrett KA, Shin JH, Trencheva K, Sonoda T, Milsom JW. Dynamic article: long-term outcomes of patients undergoing combined endolaparoscopic surgery for benign colon polyps. Dis Colon Rectum. 2013;56(7):869–73.CrossRefGoogle Scholar
  21. 21.
    Din S, Ball AJ, Taylor E, Rutter M, Riley SA, Johal S. Polypectomy practices of sub-centimeter polyps in the English Bowel Cancer Screening Programme. Surg Endosc. 2015; 29(11): 3224-3230.CrossRefGoogle Scholar
  22. 22.
    Singh N, Harrison M, Rex DK. A survey of colonoscopic polypectomy practices among clinical gastroenterologists. Gastrointest Endosc. 2004;60(3):414–8.CrossRefGoogle Scholar
  23. 23.
    Kedia P, Waye JD. Colon polypectomy: a review of routine and advanced techniques. J Clin Gastroenterol. 2013;47(8):657–65.CrossRefGoogle Scholar
  24. 24.
    Rex DK. Preventing colorectal cancer and cancer mortality with colonoscopy: What we know and what we don’t know. Endoscopy. 2010;42(4):320–3.CrossRefGoogle Scholar
  25. 25.
    Woods A, Sanowski RA, Wadas DD, Manne RK, Friess SW. Eradication of diminutive polyps: a prospective evaluation of bipolar coagulation versus conventional biopsy removal. Gastrointest Endosc. 1989;35(6):536–40.CrossRefGoogle Scholar
  26. 26.
    Efthymiou M, Taylor AC, Desmond PV, Allen PB, Chen RY. Biopsy forceps is inadequate for the resection of diminutive polyps. Endoscopy. 2011;43(4):312–6.CrossRefGoogle Scholar
  27. 27.
    Liu S, Ho SB, Krinsky ML. Quality of polyp resection during colonoscopy: are we achieving polyp clearance? Dig Dis Sci. 2012;57(7):1786–91.CrossRefGoogle Scholar
  28. 28.
    Draganov PV, Chang MN, Alkhasawneh A, et al. Randomized, controlled trial of standard, large-capacity versus jumbo biopsy forceps for polypectomy of small, sessile, colorectal polyps. Gastrointest Endosc. 2012;75(1):118–26.CrossRefGoogle Scholar
  29. 29.
    Williams CB. Small polyps: the virtues and the dangers of hot biopsy. Gastrointest Endosc. 1991;37(3):394–5.CrossRefGoogle Scholar
  30. 30.
    Monkemuller KE, Fry LC, Jones BH, Wells C, Mikolaenko I, Eloubeidi M. Histological quality of polyps resected using the cold versus hot biopsy technique. Endoscopy. 2004;36(5):432–6.CrossRefGoogle Scholar
  31. 31.
    Vanagunas A, Jacob P, Vakil N. Adequacy of “hot biopsy” for the treatment of diminutive polyps: a prospective randomized trial. Am J Gastroenterol. 1989;84(4):383–5.PubMedGoogle Scholar
  32. 32.
    Savides TJ, See JA, Jensen DM, Jutabha R, Machicado GA, Hirabayashi K. Randomized controlled study of injury in the canine right colon from simultaneous biopsy and coagulation with different hot biopsy forceps. Gastrointest Endosc. 1995;42(6):573–8.CrossRefGoogle Scholar
  33. 33.
    Peluso F, Goldner F. Follow-up of hot biopsy forceps treatment of diminutive colonic polyps. Gastrointest Endosc. 1991;37(6):604–6.CrossRefGoogle Scholar
  34. 34.
    Gilbert DA, DiMarino AJ, Jensen DM, et al. Status evaluation: hot biopsy forceps. American society for gastrointestinal endoscopy. technology assessment committee. Gastrointest Endosc. 1992;38(6):753–6.CrossRefGoogle Scholar
  35. 35.
    Riley S. Colonoscopic polypectomy and endoscopic mucosal resection: A practical guide. http://www.bsg.org.uk/clinical-guidance/endoscopy/colonoscopic-polypectomy-and-endoscopic-mucosal-resection-a-practical-guide.html. Updated 2008. Accessed 5 June 2015.Google Scholar
  36. 36.
    Kim JS, Lee BI, Choi H, et al. Cold snare polypectomy versus cold forceps polypectomy for diminutive and small colorectal polyps: A randomized controlled trial. Gastrointest Endosc. 2015;81(3):741–7.CrossRefGoogle Scholar
  37. 37.
    Hewett DG. Colonoscopic polypectomy: current techniques and controversies. Gastroenterol Clin North Am. 2013;42(3):443–58.CrossRefGoogle Scholar
  38. 38.
    Paspatis GA, Tribonias G, Konstantinidis K, et al. A prospective randomized comparison of cold vs hot snare polypectomy in the occurrence of postpolypectomy bleeding in small colonic polyps. Colorectal Dis. 2011;13(10):e345–8.CrossRefGoogle Scholar
  39. 39.
    Lee CK, Shim JJ, Jang JY. Cold snare polypectomy vs. cold forceps polypectomy using double-biopsy technique for removal of diminutive colorectal polyps: a prospective randomized study. Am J Gastroenterol. 2013;108(10):1593–600.CrossRefGoogle Scholar
  40. 40.
    Ichise Y, Horiuchi A, Nakayama Y, Tanaka N. Prospective randomized comparison of cold snare polypectomy and conventional polypectomy for small colorectal polyps. Digestion. 2011;84(1):78–81.CrossRefGoogle Scholar
  41. 41.
    Van Gossum A, Cozzoli A, Adler M, Taton G, Cremer M. Colonoscopic snare polypectomy: Analysis of 1485 resections comparing two types of current. Gastrointest Endosc. 1992;38(4):472–5.CrossRefGoogle Scholar
  42. 42.
    Repici A, Pellicano R, Strangio G, Danese S, Fagoonee S, Malesci A. Endoscopic mucosal resection for early colorectal neoplasia: pathologic basis, procedures, and outcomes. Dis Colon Rectum. 2009;52(8):1502–15.CrossRefGoogle Scholar
  43. 43.
    Conio M, Blanchi S, Repici A, Ruggeri C, Fisher DA, Filiberti R. Cap-assisted endoscopic mucosal resection for colorectal polyps. Dis Colon Rectum. 2010;53(6):919–27.CrossRefGoogle Scholar
  44. 44.
    Moss A, Bourke MJ, Williams SJ, et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology. 2011;140(7):1909–18.CrossRefGoogle Scholar
  45. 45.
    Moss A, Williams SJ, Hourigan LF, et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the australian colonic EMR (ACE) study. Gut. 2015;64(1):57–65.CrossRefGoogle Scholar
  46. 46.
    Luigiano C, Consolo P, Scaffidi MG, et al. Endoscopic mucosal resection for large and giant sessile and flat colorectal polyps: a single-center experience with long-term follow-up. Endoscopy. 2009;41(10):829–35.CrossRefGoogle Scholar
  47. 47.
    Buchner AM, Guarner-Argente C, Ginsberg GG. Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center. Gastrointest Endosc. 2012;76(2):255–63.CrossRefGoogle Scholar
  48. 48.
    Steele SR, Johnson EK, Champagne B, et al. Endoscopy and polyps-diagnostic and therapeutic advances in management. World J Gastroenterol. 2013;19(27):4277–88.CrossRefGoogle Scholar
  49. 49.
    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver.3). Gastric Cancer. 2011;14:113–23.CrossRefGoogle Scholar
  50. 50.
    Gotoda T, Ho KY, Soetikno R, Kaltenbach T, Draganov P. Gastric ESD: current status and future directions of devices and training. Gastrointest Endosc Clin N Am. 2014;24(2):213–33.CrossRefGoogle Scholar
  51. 51.
    Draganov PV, Gotoda T, Chavalitdhamrong D, Wallace MB. Techniques of endoscopic submucosal dissection: application for the western endoscopist? Gastrointest Endosc. 2013;78(5):677–88.CrossRefGoogle Scholar
  52. 52.
    Ono S, Fujishiro M, Koike K. Endoscopic submucosal dissection for superficial esophageal neoplasms. World J Gastrointest Endosc. 2012;4(5):162–6.CrossRefGoogle Scholar
  53. 53.
    Oda I, Suzuki H, Nonaka S, Yoshinaga S. Complications of gastric endoscopic submucosal dissection. Dig Endosc. 2013;25 Suppl 1:71–8.CrossRefGoogle Scholar
  54. 54.
    Tanaka S, Kashida H, Saito Y, et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2015;27(4):417–34.CrossRefGoogle Scholar
  55. 55.
    Deprez PH, Bergman JJ, Meisner S, et al. Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts. Endoscopy. 2010;42(10):853–8.CrossRefGoogle Scholar
  56. 56.
    Bhatt A, Abe S, Kumaravel A, Vargo J, Saito Y. Indications and techniques for endoscopic submucosal dissection. Am J Gastroenterol. 2015.Google Scholar
  57. 57.
    Huai ZY, Feng Xian W, Chang Jiang L, Xi Chen W. Submucosal injection solution for endoscopic resection in gastrointestinal tract: a traditional and network meta-analysis. Gastroenterol Res Pract. 2015;2015:702768.Google Scholar
  58. 58.
    Probst A, Golger D, Anthuber M, Markl B, Messmann H. Endoscopic submucosal dissection in large sessile lesions of the rectosigmoid: learning curve in a european center. Endoscopy. 2012;44(7):660–7.CrossRefGoogle Scholar
  59. 59.
    Hotta K, Oyama T, Shinohara T, et al. Learning curve for endoscopic submucosal dissection of large colorectal tumors. Dig Endosc. 2010;22(4):302–6.CrossRefGoogle Scholar
  60. 60.
    Saito Y, Uraoka T, Yamaguchi Y, et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc. 2010;72(6):1217–25.CrossRefGoogle Scholar
  61. 61.
    Kobayashi N, Yoshitake N, Hirahara Y, et al. Matched case–control study comparing endoscopic submucosal dissection and endoscopic mucosal resection for colorectal tumors. J Gastroenterol Hepatol. 2012;27(4):728–33.CrossRefGoogle Scholar
  62. 62.
    Steele SR, Brown TA, Rush RM, Martin MJ. Laparoscopic vs open colectomy for colon cancer: results from a large nationwide population-based analysis. J Gastrointest Surg. 2008;12(3):583–91.CrossRefGoogle Scholar
  63. 63.
    Beck DE, Karulf RE. Laparoscopic-assisted full-thickness endoscopic polypectomy. Dis Colon Rectum. 1993;36(7):693–5.CrossRefGoogle Scholar
  64. 64.
    Franklin Jr ME, Diaz-E JA, Abrego D, Parra-Davila E, Glass JL. Laparoscopic-assisted colonoscopic polypectomy: the Texas Endosurgery Institute experience. Dis Colon Rectum. 2000;43(9):1246–9.CrossRefGoogle Scholar
  65. 65.
    Wilhelm D, von Delius S, Weber L, et al. Combined laparoscopic-endoscopic resections of colorectal polyps: 10-year experience and follow-up. Surg Endosc. 2009;23(4):688–93.CrossRefGoogle Scholar
  66. 66.
    Ommer A, Limmer J, Mollenberg H, Peitgen K, Albrecht KH, Walz MK. Laparoscopic-assisted colonoscopic polypectomy—indications and results. Zentralbl Chir. 2003;128(3):195–8.CrossRefGoogle Scholar
  67. 67.
    Franklin Jr ME, Leyva-Alvizo A, Abrego-Medina D, et al. Laparoscopically monitored colonoscopic polypectomy: an established form of endoluminal therapy for colorectal polyps. Surg Endosc. 2007;21(9):1650–3.CrossRefGoogle Scholar
  68. 68.
    Winter H, Lang RA, Spelsberg FW, Jauch KW, Huttl TP. Laparoscopic colonoscopic rendezvous procedures for the treatment of polyps and early stage carcinomas of the colon. Int J Colorectal Dis. 2007;22(11):1377–81.CrossRefGoogle Scholar
  69. 69.
    Lee SW, Garrett KA, Shin JH, Trencheva K, Sonoda T, Milsom JW. Dynamic article: long-term outcomes of patients undergoing combined endolaparoscopic surgery for benign colon polyps. Dis Colon Rectum. 2013;56(7):869–73.CrossRefGoogle Scholar
  70. 70.
    Yan J, Trencheva K, Lee SW, Sonoda T, Shukla P, Milsom JW. Treatment for right colon polyps not removable using standard colonoscopy: combined laparoscopic-colonoscopic approach. Dis Colon Rectum. 2011;54(6):753–8.CrossRefGoogle Scholar
  71. 71.
    Franklin Jr ME, Portillo G. Laparoscopic monitored colonoscopic polypectomy: long-term follow-up. World J Surg. 2009;33(6):1306–9.CrossRefGoogle Scholar

Copyright information

© ASCRS (American Society of Colon and Rectal Surgeons) 2016

Open Access This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial 2.5 International License (http://creativecommons.org/licenses/by-nc/2.5/), which permits any noncommercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Authors and Affiliations

  1. 1.Department of General Surgery, Section of Colon and Rectal SurgeryWeill Cornell Medical College, New York Presbyterian HospitalNew YorkUSA
  2. 2.Department of SurgeryKeck School of Medicine, University of Southern CaliforniaLos AngelesUSA

Personalised recommendations