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Endoscopic Characterization of Colorectal Lesions and Resection Strategy

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Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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Abstract

Endoscopic resection (ER) has become the treatment of choice for colorectal neoplasia. Over the last decades, different resection techniques have been developed (hot snare polypectomy (HSP), cold snare polypectomy (CSP), endoscopic mucosal resection (EMR) after submucosal injection, underwater EMR (UEMR) without submucosal injection, endoscopic submucosal dissection (ESD) and endoscopic full thickness resection (EFTR)). The decision for the optimal resection technique has to be made prior to ER individually. It depends on the lesion’s morphology (pedunculated versus sessile), the lesion’s size, the lesion’s location, and especially on the estimated risk of submucosal invasive cancer and the expertise of the endoscopist. For choosing the ideal resection method, endoscopic characterization of each lesion is mandatory. Advanced imaging is recommended especially for sessile lesions to estimate the risk for submucosal invasion. While gross features such as size, color, and location are easy to describe, more salient features, such as the mucosal surface pattern and the vascular architecture, may be more difficult to appreciate and interpret, especially for nonexpert endoscopists. For lesions showing a risk for superficial submucosal invasion, en bloc resection should be attempted (en bloc EMR or ESD depending on the lesions size). In contrast, piecemeal resection is acceptable for lesions with presumable benign histology which represent the vast majority of colorectal neoplasia.

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Authors and Affiliations

  1. III. Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany

    Helmut Messmann, Andreas Probst & Alanna Ebigbo

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  1. Helmut Messmann
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  2. Andreas Probst
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  3. Alanna Ebigbo
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Correspondence to Helmut Messmann .

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Editors and Affiliations

  1. Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, MILANO, Milano, Italy

    Pier Alberto Testoni

  2. Digestive Diseases Center, Showa University Hospital, Tokyo, Japan

    Haruhiro Inoue

  3. Div. of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA

    Michael B. Wallace

Section Editor information

  1. Cancer Center, Mayo Clinic, Jacksonville, FL, USA

    Michael B. Wallace

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Messmann, H., Probst, A., Ebigbo, A. (2020). Endoscopic Characterization of Colorectal Lesions and Resection Strategy. In: Testoni, P.A., Inoue, H., Wallace, M.B. (eds) Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-29964-4_17-1

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  • DOI: https://doi.org/10.1007/978-3-030-29964-4_17-1

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