Published online Jan 21, 2019. doi: 10.3748/wjg.v25.i3.300
Peer-review started: October 5, 2018
First decision: November 7, 2018
Revised: November 30, 2018
Accepted: December 13, 2018
Article in press: December 13, 2018
Published online: January 21, 2019
Endoscopic polypectomy and endoscopic mucosal resection (EMR) are the established treatment standards for colorectal polyps. Current research aims at the reduction of both complication and recurrence rates as well as on shortening procedure times. Cold snare resection is the emerging standard for the treatment of smaller (< 5mm) polyps and is possibly also suitable for the removal of non-cancerous polyps up to 9 mm. The method avoids thermal damage, has reduced procedure times and probably also a lower risk for delayed bleeding. On the other end of the treatment spectrum, endoscopic submucosal dissection (ESD) offers en bloc resection of larger flat or sessile lesions. The technique has obvious advantages in the treatment of high-grade dysplasia and early cancer. Due to its minimal recurrence rate, it may also be an alternative to fractionated EMR of larger flat or sessile lesions. However, ESD is technically demanding and burdened by longer procedure times and higher costs. It should therefore be restricted to lesions suspicious for high-grade dysplasia or early invasive cancer. The latest addition to endoscopic resection techniques is endoscopic full-thickness resection with specifically developed devices for flexible endoscopy. This method is very useful for the treatment of smaller difficult-to-resect lesions, e.g., recurrence with scar formation after previous endoscopic resections.
Core tip: Endoscopic polypectomy and endoscopic mucosal resection are the standard treatment options for colorectal neoplasia. Current research is evaluating cold snare resection for the treatment of smaller non-cancerous polyps, aiming to reduce procedure times and complication rates. Endoscopic submucosal dissection has great potential for the en bloc resection of larger flat or sessile lesions. However, it is technically demanding and time consuming and should be reserved for histologically advanced lesions. Endoscopic full-thickness resection is a welcome addition to the armamentarium of endoscopic resection techniques and is very useful for the treatment of smaller difficult-to-resect lesions.