Management of local recurrence after endoscopic resection of neoplastic colonic polyps |
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Authors: | Satoki Shichijo Yoji Takeuchi Noriya Uedo Ryu Ishihara |
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Institution: | Satoki Shichijo, Yoji Takeuchi, Noriya Uedo, Ryu Ishihara, Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka 541-8567, Chuo-ku, Japan |
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Abstract: | A proportion of neoplastic polyps are incompletely resected, resulting in local recurrence, especially after resection of large polyps or piecemeal resection. Local recurrences that develop after endoscopic resection of intramucosal neoplasms that lacked risk factors for lymph node metastasis or positive vertical margins are usually treated endoscopically. Endoscopic submucosal dissection (ESD) is indicated for local residual or recurrent early carcinomas after endoscopic resection. However, ESD for such recurrent lesions is technically difficult and is typically a lengthy procedure. Underwater endoscopic mucosal resection (UEMR), which was developed in 2012, is suitable for recurrent or residual lesions and reportedly achieves superior en bloc resection rates and endoscopic complete resection rates than conventional EMR. However, a large recurrent lesion is a negative independent predictor of successful en bloc resection and of complete endoscopic removal. We therefore perform UEMR for relatively small (≤ 10-15 mm) recurrent lesions and ESD for larger lesions. |
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Keywords: | Recurrence Endoscopic management Colon Endoscopic submucosal dissection Underwater endoscopic mucosal resection Polyp Endoscopic resection Fibrosis Non-lifting sign |
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