J Korean Med Assoc.  2023 Nov;66(11):642-651. 10.5124/jkma.2023.66.11.642.

Endoscopic treatment of colorectal polyps and early colorectal cancer

• Jung Y

• KMID: 2547774
• DOI: http://doi.org/10.5124/jkma.2023.66.11.642

Abstract

Background
Colonoscopy offers higher diagnostic sensitivity than other colorectal cancer screening methods and provides the advantage of both diagnostic tissue sampling and polyp removal. Since the majority of colorectal cancers evolve from adenomatous polyps, polyp resection through colonoscopy is widely considered an effective method of preventing colorectal cancer and reducing mortality rates.
Current Concepts
Determining colorectal polyp size and shape requires comprehensive endoscopy with enhanced imaging techniques to choose treatment directions and the appropriate colorectal polypectomy method. The selection of the polypectomy method is contingent upon the polyp’s attributes and possible malignancy according to US Multi-Society Task Force on Colorectal Cancer and European gastrointestinal endoscopy guidelines. This article examines eight polypectomy procedures: cold forceps polypectomy, hot biopsy polypectomy, cold snare polypectomy, hot snare polypectomy, endoscopic mucosal resection (EMR), and modified EMR techniques. Each method has unique benefits and is suitable for particular polyp types and sizes. Piecemeal EMR and endoscopic submucosal dissection offer alternatives for larger or challenging lesions that require careful planning and follow-up. After endoscopic resection of early colorectal cancer, further surgery may be necessary depending on the risk of lymph node metastasis as determined by specific histologic findings following Korean and Japanese guidelines.
Discussion and Conclusion
The choice of endoscopic resection technique, which depends on factors such as polyp shape, size, and location as well as endoscopist skill, is crucial for ensuring complete polyp removal.

Keyword

Colonoscopy; Colorectal cancer; Colonic polyps; Therapeutics; 대장내시경; 대장암; 대장 용종; 치료