Published online Jun 15, 2017. doi: 10.4251/wjgo.v9.i6.251
Peer-review started: Janaury 12, 2017
First decision: March 7, 2017
Revised: April 3, 2017
Accepted: May 22, 2017
Article in press: May 24, 2017
Published online: June 15, 2017
To evaluate a step up approach: Taking macrobiopsies and performing excision biopsies in patients with suspected rectal cancer in which biopsies taken though the flexible endoscope showed benign histology.
Patients with a rectal neoplasm who underwent flexible endoscopy and biopsies were included. In case of benign biopsies rigid rectoscopy and macrobiopsies were employed. If this failed to prove malignancy, transanal endoscopic microsurgery (TEM) was used in a final effort to establish a certain preoperative diagnosis. The preoperative results were compared with the findings after surgical excision and follow up to calculate the reliability of this algorithm.
One hundred and thirty-two patients were included. One hundred and ten patients with a carcinoma and 22 with an adenoma. Seventy-five of 110 carcinomas were proven malignant after flexible endoscopy. With the addition of rigid endoscopy and taking of macrobiopsies, this number increased to 89. Performing TEM excision biopsies further enlarged the number of proven malignancies to 100.
The step-up approach includes taking macrobiopsies through the rigid rectoscope and performing excision biopsies using transanal endoscopic microsurgery in addition to flexible endoscopy. This approach, reduced the number of missed preoperative malignant diagnoses from 32% to 9%.
Core tip: Increasing the number of biopsies taken through a flexible endoscope, taking macrobiopsies and performing excision biopsies with transanal endoscopic microsurgery can reduce the number of missed preoperative malignant diagnoses in patients with rectal cancer.