Published online Dec 16, 2018. doi: 10.4253/wjge.v10.i12.378
Peer-review started: August 20, 2018
First decision: October 5, 2018
Revised: October 17, 2018
Accepted: November 7, 2018
Article in press: November 8, 2018
Published online: December 16, 2018
Processing time: 125 Days and 1.3 Hours
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.
Core tip: Local recurrences of neoplastic colonic polyps can occur, 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. We perform underwater endoscopic mucosal resection for relatively small (≤ 10-15 mm) recurrent lesions and endoscopic submucosal dissection for larger lesions.