Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Bonn 53113, Germany.
Institute for Pathology, Bonn Duisdorf, Bonn 53123, Germany.
World J Gastroenterol. 2019 Jan 21;25(3):300-307. doi: 10.3748/wjg.v25.i3.300.
Endoscopic polypectomy and endoscopic mucosal resection (EMR) are the established treatment standards for colorectal polyps. Current research aims at the reduction of both complication and recurrence rates as well as on shortening procedure times. Cold snare resection is the emerging standard for the treatment of smaller (< 5mm) polyps and is possibly also suitable for the removal of non-cancerous polyps up to 9 mm. The method avoids thermal damage, has reduced procedure times and probably also a lower risk for delayed bleeding. On the other end of the treatment spectrum, endoscopic submucosal dissection (ESD) offers resection of larger flat or sessile lesions. The technique has obvious advantages in the treatment of high-grade dysplasia and early cancer. Due to its minimal recurrence rate, it may also be an alternative to fractionated EMR of larger flat or sessile lesions. However, ESD is technically demanding and burdened by longer procedure times and higher costs. It should therefore be restricted to lesions suspicious for high-grade dysplasia or early invasive cancer. The latest addition to endoscopic resection techniques is endoscopic full-thickness resection with specifically developed devices for flexible endoscopy. This method is very useful for the treatment of smaller difficult-to-resect lesions, ., recurrence with scar formation after previous endoscopic resections.
内镜息肉切除术和内镜黏膜切除术（EMR）是结直肠息肉的既定治疗标准。目前的研究旨在降低并发症和复发率，并缩短手术时间。冷圈套切除术是治疗较小（<5mm）息肉的新兴标准，也可能适用于切除非癌性息肉，最大可达 9mm。该方法避免了热损伤，缩短了手术时间，并且可能延迟出血的风险也较低。在治疗范围的另一端，内镜黏膜下剥离术（ESD）提供了较大平坦或无蒂病变的切除。该技术在治疗高级别异型增生和早期癌症方面具有明显的优势。由于其复发率低，也可能是较大平坦或无蒂病变分次 EMR 的替代方法。然而，ESD 技术要求高，手术时间长，费用高。因此，它应仅限于高度异型增生或早期浸润性癌的病变。内镜切除技术的最新进展是使用专门为软性内镜开发的设备进行内镜全层切除术。这种方法对于治疗较小的难以切除的病变非常有用，例如先前内镜切除后复发伴有瘢痕形成的病变。
