Published online Jul 21, 2013. doi: 10.3748/wjg.v19.i27.4277
Revised: June 6, 2013
Accepted: June 8, 2013
Published online: July 21, 2013
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.
Core tip: Changes in polyp detection including chromoendoscopy and narrow band imaging, as well as reliance on quality indicators such as the 6-min withdrawal time, aim to improve adenoma detection rates. Once identified, novel approaches for large and advanced polyps such as endoscopic submucosal dissection and endoscopic mucosal resection, combined laparoscopic-endoscopic resection along with combined endoscopic-laparoscopic resection are available to surgeons that may obviate the need for formal resection. Although technical expertise and experience is required, physicians caring for these patients should be familiar with each of these alternative procedures.