Endoscopic mucosal resection provides an alternative to surgery for resection of sessile and flat colorectal lesions.
In addition, high-magnification chromoscopic colonoscopy may allow early detection and anticipate histological diagnosis by identifying colonic crypt patterns.
In this study, doctors from England assessed en-bloc endoscopic mucosal resection with high-magnification chromoendoscopy for the management of sessile and flat colorectal lesions.
A single endoscopist examined 1000 patients attending for routine colonoscopy.
The team selected patients for inclusion in the study if they were considered to be at high risk for underlying colorectal neoplasia or polyps.
The team performed endoscopic mucosal resection in 599 appropriate flat and sessile lesions; complete histological resection was confirmed in 96 %.
They found that perforation occurred in 1 patient, and bleeding in 12.
The doctors found that 58 flat lesions contained high-grade dysplasia or beyond, compared to 33 sessile lesions.
Dr Hurlstone and colleagues concluded, “This study confirms that flat adenomas and carcinomas occur in the West and demonstrates the malignant potential of such lesions, which can be managed successfully using endoscopic techniques”.
“Endoscopic mucosal resection with high-magnification chromoscopy is a safe and effective form of treatment for sessile or flat colorectal lesions”.
“Complete resection can improve the accuracy of histopathological diagnosis”.
“However, colonoscopists require training in these procedures in order to improve the rate of colorectal cancer detection”.