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Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2022; 14(7): 632-655
Published online Jul 27, 2022. doi: 10.4240/wjgs.v14.i7.632
From advanced diagnosis to advanced resection in early neoplastic colorectal lesions: Never-ending and trending topics in the 2020s
Francesco Auriemma, Sandro Sferrazza, Mario Bianchetti, Maria Flavia Savarese, Laura Lamonaca, Danilo Paduano, Nicole Piazza, Enrica Giuffrida, Lupe Sanchez Mete, Alessandra Tucci, Sebastian Manuel Milluzzo, Chiara Iannelli, Alessandro Repici, Benedetto Mangiavillano
Francesco Auriemma, Laura Lamonaca, Danilo Paduano, Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza 21053, Italy
Sandro Sferrazza, Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento 38014, Italy
Mario Bianchetti, Digestive Endoscopy Unit, San Giuseppe Hospital - Multimedica, Milan 20123, Italy
Maria Flavia Savarese, Department of Gastroenterology and Gastrointestinal Endoscopy, General Hospital, Sanremo 18038, Italy
Nicole Piazza, Gastroenterology Unit, IRCCS Policlinico San Donato, San Donato Milanese; Department of Biomedical Sciences for Health, University of Milan, Milan 20122, Italy
Enrica Giuffrida, Gastroenterology and Hepatology Unit, A.O.U. Policlinico “G. Giaccone", Palermo 90127, Italy
Lupe Sanchez Mete, Department of Gastroenterology and Digestive Endoscopy, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
Alessandra Tucci, Department of Gastroenterology, Molinette Hospital, Città della salute e della Scienza di Torino, Turin 10126, Italy
Sebastian Manuel Milluzzo, Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia 25100, Italy
Chiara Iannelli, Department of Health Sciences, Magna Graecia University, Catanzaro 88100, Italy
Alessandro Repici, Digestive Endoscopy Unit and Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano 20089, Italy
Benedetto Mangiavillano, Biomedical Science, Hunimed, Pieve Emanuele 20090, Italy
Benedetto Mangiavillano, Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Varese 21053, Italy
Author contributions: Auriemma F, Mangiavillano B, and Repici A conceptualized the paper, promoted the writing, and reviewed the final draft and acceptance; Sferrazza S, Savarese MF, Lamonaca L, Milluzzo SM, Giuffrida E, Mete LS, Iannelli C, Tucci A, Piazza N, Bianchetti M, and Paduano D contributed to writing and draft acceptance.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Benedetto Mangiavillano, MD, Chief Doctor, Biomedical Science, Hunimed, 4, Rita Levi Montalcini Street, 20072, Pieve Emanuele 20090, Italy. benedetto.mangiavillano@materdomini.it
Received: February 7, 2021
Peer-review started: February 7, 2021
First decision: March 16, 2021
Revised: May 2, 2021
Accepted: June 20, 2022
Article in press: June 20, 2022
Published online: July 27, 2022
Processing time: 534 Days and 12.7 Hours
Abstract

Colonoscopy represents the most widespread and effective tool for the prevention and treatment of early stage preneoplastic and neoplastic lesions in the panorama of cancer screening. In the world there are different approaches to the topic of colorectal cancer prevention and screening: different starting ages (45-50 years); different initial screening tools such as fecal occult blood with immunohistochemical or immune-enzymatic tests; recto-sigmoidoscopy; and colonoscopy. The key aspects of this scenario are composed of a proper bowel preparation that ensures a valid diagnostic examination, experienced endoscopist in detection of preneoplastic and early neoplastic lesions and open-minded to upcoming artificial intelligence-aided examination, knowledge in the field of resection of these lesions (from cold-snaring, through endoscopic mucosal resection and endoscopic submucosal dissection, up to advanced tools), and management of complications.

Keywords: Colorectal lesions; Colorectal tumor; Endoscopic submucosal dissection; Endoscopic mucosal resection; Cold-endoscopic mucosal resection; FTRD®; Complications; Adverse events; Polypectomy

Core Tip: Appropriate bowel preparation is related with valuable outcomes in colorectal cancer screening. Artificial intelligence may represent an adjunctive methodology for standardizing endoscopy practice. Cold snare polypectomy emerged as a new approach for resection of superficial benign lesions. Endoscopic submucosal dissection has been widely recognized as an indispensable procedure for early superficial neoplastic lesions able to avoid unnecessary major surgery. Advanced techniques such as full-thickness resection and non-thermal avulsion represent valid tools for recurrent/non-lifting lesions.