title: Endoscopy and polyps-diagnostic and therapeutic advances in management.
abstract: Despite multiple efforts aimed at early detection through screening, colon cancer remains the third leading cause of cancer-related deaths in the United States, with an estimated 51000 deaths during 2013 alone. The goal remains to identify and remove benign neoplastic polyps prior to becoming invasive cancers. Polypoid lesions of the colon vary widely from hyperplastic, hamartomatous and inflammatory to neoplastic adenomatous growths. Although these lesions are all benign, they are common, with up to one-quarter of patients over 60 years old will develop pre-malignant adenomatous polyps. Colonoscopy is the most effective screening tool to detect polyps and colon cancer, although several studies have demonstrated missed polyp rates from 6%-29%, largely due to variations in polyp size. This number can be as high as 40%, even with advanced (> 1 cm) adenomas. Other factors including sub-optimal bowel preparation, experience of the endoscopist, and patient anatomical variations all affect the detection rate. Additional challenges in decision-making exist when dealing with more advanced, and typically larger, polyps that have traditionally required formal resection. In this brief review, we will explore the recent advances in polyp detection and therapeutic options.
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Madigan Health System, Tacoma, WA 98431, USA. harkersteele@mac.com
authors.forename: Scott R
authors.initials: SR
authors.lastname: Steele
authors.forename: Eric K
authors.initials: EK
authors.lastname: Johnson
authors.forename: Bradley
authors.initials: B
authors.lastname: Champagne
authors.forename: Brad
authors.initials: B
authors.lastname: Davis
authors.forename: Sang
authors.initials: S
authors.lastname: Lee
authors.forename: David
authors.initials: D
authors.lastname: Rivadeneira
authors.forename: Howard
authors.initials: H
authors.lastname: Ross
authors.forename: Dana A
authors.initials: DA
authors.lastname: Hayden
authors.forename: Justin A
authors.initials: JA
authors.lastname: Maykel
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000628:therapy; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D003111:Colonic Polyps / Q000175:diagnosis* / Q000628:therapy*; D003113:Colonoscopy / Q000379:methods*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D010535:Laparoscopy / Q000379:methods; D011230:Precancerous Conditions; D012008:Recurrence; D016896:Treatment Outcome
keywords: Colonoscopy; Combined endoscopic-laparoscopic resection; Combined endoscopic-laparoscopic surgery; Combined laparoscopic-endoscopic resection; Endoscopic mucosal resection; Endoscopic submucosal dissection; Endoscopy; Polyps; Quality