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The role of imaging and biopsy in the management and staging of large non-pedunculated rectal polyps

The role of imaging and biopsy in the management and staging of large non-pedunculated rectal polyps
The role of imaging and biopsy in the management and staging of large non-pedunculated rectal polyps

Introduction: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are often used for benign and Sm1 large non-pedunculated rectal polyps (LNPRPs), although other surgical techniques including transanal endoscopic microsurgery (TEMS) and transanal minimal invasive surgery remain available. This review covers the role of pre-excisional imaging and selective biopsy of LNPRPs. Areas covered: Polyps between 2 and 3 cm with favorable features (Paris 1, Kudo III/IV pit patterns, and non-lateral spreading type [LST]) may have a one-stage EMR without biopsy and imaging, provided adequate expertise is available with other technologies such as magnifying chromoendoscopy. Higher-risk polyps (moderate/severe dysplasia, 0–IIa+c morphology, nongranular LST, Kudo pit pattern V or submucosal carcinoma, or those >3 cm) should have pre-EMR/ESD imaging with magnetic resonance imaging (MRI) and/or endorectal ultrasound (ERUS) ± biopsies and photographs prior to multidisciplinary team discussion. Expert commentary: In some centers, EMR and ESD are considered the primary modality of treatment, with TEMS as a back-up, while elsewhere, TEMS is the main modality for excision of significant polyps and early colorectal cancer lesions. Likewise, the exact roles of ERUS and MRI will depend on availability of local expertise, although it is suggested that the techniques are complementary.

Colonoscopy, endorectal ultrasound, local excision, magnetic resonance imaging, polyp
1747-4124
749-755
Banerjee, Anjan K.
e8aa76ae-6bc6-4bae-aca8-6de273662e9f
Longcroft-Wheaton, Gaius
c81264ad-35a8-4601-a001-d7cfb6357863
Beable, Richard
0ac89ed0-7c31-470c-b923-c337fcd6d95e
Conti, John
4195688d-366b-4253-986b-9b3ca67598c9
Khan, Jim
acfe9543-65c1-4b7f-99ba-cbff161ff108
Bhandari, Pradeep
5d6f89f0-a69d-48d7-b182-95e7f400e1c9
Banerjee, Anjan K.
e8aa76ae-6bc6-4bae-aca8-6de273662e9f
Longcroft-Wheaton, Gaius
c81264ad-35a8-4601-a001-d7cfb6357863
Beable, Richard
0ac89ed0-7c31-470c-b923-c337fcd6d95e
Conti, John
4195688d-366b-4253-986b-9b3ca67598c9
Khan, Jim
acfe9543-65c1-4b7f-99ba-cbff161ff108
Bhandari, Pradeep
5d6f89f0-a69d-48d7-b182-95e7f400e1c9

Banerjee, Anjan K., Longcroft-Wheaton, Gaius, Beable, Richard, Conti, John, Khan, Jim and Bhandari, Pradeep (2018) The role of imaging and biopsy in the management and staging of large non-pedunculated rectal polyps. Expert Review of Gastroenterology & Hepatology, 12 (8), 749-755. (doi:10.1080/17474124.2018.1492377).

Record type: Article

Abstract

Introduction: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are often used for benign and Sm1 large non-pedunculated rectal polyps (LNPRPs), although other surgical techniques including transanal endoscopic microsurgery (TEMS) and transanal minimal invasive surgery remain available. This review covers the role of pre-excisional imaging and selective biopsy of LNPRPs. Areas covered: Polyps between 2 and 3 cm with favorable features (Paris 1, Kudo III/IV pit patterns, and non-lateral spreading type [LST]) may have a one-stage EMR without biopsy and imaging, provided adequate expertise is available with other technologies such as magnifying chromoendoscopy. Higher-risk polyps (moderate/severe dysplasia, 0–IIa+c morphology, nongranular LST, Kudo pit pattern V or submucosal carcinoma, or those >3 cm) should have pre-EMR/ESD imaging with magnetic resonance imaging (MRI) and/or endorectal ultrasound (ERUS) ± biopsies and photographs prior to multidisciplinary team discussion. Expert commentary: In some centers, EMR and ESD are considered the primary modality of treatment, with TEMS as a back-up, while elsewhere, TEMS is the main modality for excision of significant polyps and early colorectal cancer lesions. Likewise, the exact roles of ERUS and MRI will depend on availability of local expertise, although it is suggested that the techniques are complementary.

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More information

Accepted/In Press date: 20 June 2018
e-pub ahead of print date: 25 June 2018
Published date: 3 August 2018
Keywords: Colonoscopy, endorectal ultrasound, local excision, magnetic resonance imaging, polyp

Identifiers

Local EPrints ID: 424940
URI: https://eprints.soton.ac.uk/id/eprint/424940
ISSN: 1747-4124
PURE UUID: ea9d84aa-64a0-44d7-8a32-1df30546b8e6

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Date deposited: 05 Oct 2018 16:30
Last modified: 05 Oct 2018 16:30

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Contributors

Author: Anjan K. Banerjee
Author: Gaius Longcroft-Wheaton
Author: Richard Beable
Author: John Conti
Author: Jim Khan
Author: Pradeep Bhandari

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