Optimal Management of Malignant Polyps, From Endoscopic Assessment and Resection to Decisions About Surgery

Douglas K. Rex, Aasma Shaukat, Michael B Wallace

Research output: Contribution to journalReview article

Abstract

Colorectal cancer is defined clinically as invasion of dysplastic cells into the submucosa. Lesions with submucosal invasion but without invasion into the muscularis propria are generally called malignant polyps. A stepwise approach produces optimal management of malignant polyps (including polypoid and flat/depressed lesions). The first step is to avoid endoscopic resection of non-pedunculated lesions with endoscopic features that predict deep submucosal invasion. Lesions without such features are candidates for endoscopic resection. The second step is to assess candidates for endoscopic resection for features that predict an increased risk of superficial submucosal invasion. Such lesions should be considered for en bloc endoscopic excision if feasible. The third step is giving patients with endoscopically resected malignant polyps good advice regarding whether to undergo adjuvant therapy, usually surgery. We review the endoscopic and histologic criteria that guide clinicians through these steps.

Original languageEnglish (US)
Pages (from-to)1428-1437
Number of pages10
JournalClinical Gastroenterology and Hepatology
Volume17
Issue number8
DOIs
StatePublished - Jul 1 2019

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Polyps
Colorectal Neoplasms
Therapeutics

Keywords

  • Colon Polyp
  • Colorectal Cancer
  • Malignant Polyps

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Optimal Management of Malignant Polyps, From Endoscopic Assessment and Resection to Decisions About Surgery. / Rex, Douglas K.; Shaukat, Aasma; Wallace, Michael B.

In: Clinical Gastroenterology and Hepatology, Vol. 17, No. 8, 01.07.2019, p. 1428-1437.

Research output: Contribution to journalReview article

Rex, Douglas K. ; Shaukat, Aasma ; Wallace, Michael B. / Optimal Management of Malignant Polyps, From Endoscopic Assessment and Resection to Decisions About Surgery. In: Clinical Gastroenterology and Hepatology. 2019 ; Vol. 17, No. 8. pp. 1428-1437.
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