Editorial
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2018; 10(12): 378-382
Published online Dec 16, 2018. doi: 10.4253/wjge.v10.i12.378
Management of local recurrence after endoscopic resection of neoplastic colonic polyps
Satoki Shichijo, Yoji Takeuchi, Noriya Uedo, Ryu Ishihara
Satoki Shichijo, Yoji Takeuchi, Noriya Uedo, Ryu Ishihara, Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka 541-8567, Chuo-ku, Japan
Author contributions: Shichijo S drafted the article; Takeuchi Y, Uedo N and Ishihara R made critical revision and final approval of the article.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Satoki Shichijo, MD, PhD, Chief Doctor, Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Osaka 541-8567, Chuo-ku, Japan. shichijiyou-tky@umin.ac.jp
Telephone: +81-6-69451181 Fax: +81-6-69451902
Received: August 20, 2018
Peer-review started: August 20, 2018
First decision: October 5, 2018
Revised: October 17, 2018
Accepted: November 7, 2018
Article in press: November 8, 2018
Published online: December 16, 2018
Abstract

A proportion of neoplastic polyps are incompletely resected, resulting in local recurrence, especially after resection of large polyps or piecemeal resection. Local recurrences that develop after endoscopic resection of intramucosal neoplasms that lacked risk factors for lymph node metastasis or positive vertical margins are usually treated endoscopically. Endoscopic submucosal dissection (ESD) is indicated for local residual or recurrent early carcinomas after endoscopic resection. However, ESD for such recurrent lesions is technically difficult and is typically a lengthy procedure. Underwater endoscopic mucosal resection (UEMR), which was developed in 2012, is suitable for recurrent or residual lesions and reportedly achieves superior en bloc resection rates and endoscopic complete resection rates than conventional EMR. However, a large recurrent lesion is a negative independent predictor of successful en bloc resection and of complete endoscopic removal. We therefore perform UEMR for relatively small (≤ 10-15 mm) recurrent lesions and ESD for larger lesions.

Keywords: Recurrence, Endoscopic management, Colon, Endoscopic submucosal dissection, Underwater endoscopic mucosal resection, Polyp, Endoscopic resection, Fibrosis, Non-lifting sign

Core tip: Local recurrences of neoplastic colonic polyps can occur, especially after resection of large polyps or piecemeal resection. Local recurrences that develop after endoscopic resection of intramucosal neoplasms that lacked risk factors for lymph node metastasis or positive vertical margins are usually treated endoscopically. We perform underwater endoscopic mucosal resection for relatively small (≤ 10-15 mm) recurrent lesions and endoscopic submucosal dissection for larger lesions.