title: Update on Difficult Polypectomy Techniques.
abstract: Endoscopists often encounter colon polyps that are technically difficult to resect. These lesions traditionally were managed surgically, with significant potential morbidity and mortality. Recent advances in endoscopic techniques and instruments have allowed endoscopists to safely and effectively remove colorectal lesions with high technical and clinical success and potentially avoid invasive surgery. Endoscopic mucosal resection (EMR) has gained acceptance as the first-line therapy for large colorectal lesions. Endoscopic submucosal dissection (ESD) has been reported to be associated with higher rate of en bloc resection and less risk of short-time recurrence, but with an increased risk of adverse events. Therefore, the role of colorectal ESD should be restricted to lesions with high-risk morphologic features of submucosal invasion. In this article, we review the recent literature on the endoscopic management of difficult colorectal neoplasms.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 1800 Orleans Street, Zayed Bldg, Suite 7125B, Baltimore, MD, 21287, USA.
authors.forename: Saowanee
authors.initials: S
authors.lastname: Ngamruengphong
authors.affiliation: Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.|Department of Gastroenterology, VA Medical Center White River Junction, White River Junction, VT, USA.
authors.forename: Heiko
authors.initials: H
authors.lastname: Pohl
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 1800 Orleans Street, Zayed Bldg, Suite 7125B, Baltimore, MD, 21287, USA.
authors.forename: Yamile
authors.initials: Y
authors.lastname: Haito-Chavez
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 1800 Orleans Street, Zayed Bldg, Suite 7125B, Baltimore, MD, 21287, USA. mkhasha1@jhmi.edu.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
mesh_terms: D000236:Adenoma / Q000601:surgery; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods; D015179:Colorectal Neoplasms / Q000601:surgery*; D004210:Dissection / Q000379:methods; D004564:Electrocoagulation / Q000379:methods; D006801:Humans; D008207:Lymphatic Metastasis; D012307:Risk Factors
keywords: Adenoma; Colonic polyps; Colonoscopy; Endoscopic resection; Polypectomy