Letter to the Editor Open Access
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2022; 28(32): 4741-4743
Published online Aug 28, 2022. doi: 10.3748/wjg.v28.i32.4741
Is endoscopic mucosal ablation a valid option for treating colon polyps?
Xiang-Yu Liu, Ran-Ran Ren, Chen Wu, Ling-Yun Wang, Department of Gastroenterology, Jining No. 1 People's Hospital, Jining 272000, Shandong Province, China
Chen Wu, College of Clinical Medicine, Jining Medical University, Jining 272013, Shandong Province, China
Mei-Lin Zhu, Department of Geriatrics, Jining No. 1 People's Hospital, Jining 272000, Shandong Province, China
ORCID number: Xiang-Yu Liu (0000-0003-4702-976X); Ran-Ran Ren (0000-0002-2287-373X); Chen Wu (0000-0003-1352-8931); Ling-Yun Wang (0000-0003-4514-7498); Mei-Lin Zhu (0000-0003-3830-5494).
Author contributions: Liu XY and Ren RR contributed equally to this work; Liu XY, Wu C and Ren RR wrote the manuscript; Zhu ML, Wang LY and Ren RR searched the relevant literature; Liu XY and Zhu ML revised the manuscript; all authors have read and approve the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mei-Lin Zhu, MD, Attending Doctor, Department of Geriatrics, Jining No. 1 People's Hospital, No. 6 Jiankang Road, Jining 272000, Shandong Province, China. yibeinaica@126.com
Received: May 3, 2022
Peer-review started: May 3, 2022
First decision: June 19, 2022
Revised: June 24, 2022
Accepted: July 25, 2022
Article in press: July 25, 2022
Published online: August 28, 2022

Abstract

The present letter to editor is related to endoscopic mucosal ablation (EMA). EMA is safe and effective in the treatment of colonic polyps when endoscopic resection is not possible or available, but the indication of EMA should be determined for a further large number of studies. EMA should be used with caution for larger lesions.

Key Words: Endoscopy, Mucosal ablation, Colon polyp, Endoscopic mucosal ablation

Core Tip: Endoscopic mucosal ablation (EMA) is safe and effective in the treatment of colonic polyps when endoscopic resection is not possible or available, but we think EMA should be more cautious with caution for larger lesions.



TO THE EDITOR

We were pleased to read the excellent article published by Mendoza Ladd et al[1]. Their report showed a new and safe method for treating colon polyps. Patients were followed up for 1 year and showed no polyp recurrence. However, this study still has issues that we would like to discuss with the authors.

We want to know the indications for the endoscopic mucosal ablation (EMA) method, such as the size of the lesion and the type of preoperative pathology. Argon plasma coagulation is often used for benign diseases or small polyps or as a supplement when there is residual tumor or recurrence after endoscopic mucosal resection[2-5] or endoscopic submucosal dissection[6,7]. For large lesions of the colon, especially laterally spreading tumors, lesions often become high-grade intraepithelial neoplasias or even cancers[8]. Chemical staining, image enhancement endoscopy (such as narrow band imaging and blue laser imaging), magnifying endoscopy or confocal laser endomicroscopy[9] is needed to help make a diagnosis. If the lesion is high-grade internal neoplasia or cancer, the presurgery computed tomography examination needs to be improved to detect lymph node metastasis. During surgery, how to judge the integrity of the lesion and its marginal treatment needs to be further explored.

The main drawback of EMA is that it cannot produce complete specimens for pathological analysis. The pathology of the preoperative lesion biopsy may not reflect the entire lesion condition. We cannot know whether the lesion has high-grade intraepithelial neoplasia or carcinoma, nor can we determine whether the patient needs additional surgical treatment. Although the review of colonoscopy and biopsy after 1 year did not reveal lesion recurrence, lesions can take longer to recur.

In summary, the indication of EMA should be determined from a large number of studies. EMA should be used with caution for larger lesions.

Footnotes

Provenance and peer review: Unsolicited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Gastroenterology and hepatology

Country/Territory of origin: China

Peer-review report’s scientific quality classification

Grade A (Excellent): A

Grade B (Very good): B

Grade C (Good): 0

Grade D (Fair): 0

Grade E (Poor): 0

P-Reviewer: Nakaji K, Japan; Trna J, Czech Republic S-Editor: Fan JR L-Editor: A P-Editor: Fan JR

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