Colonoscopy: the current king of the hill in the United States

Colonoscopy is the dominant colorectal cancer screening strategy in the USA. There are no randomized controlled trials completed of screening colonoscopy, but multiple lines of evidence establish that colonoscopy reduces colorectal cancer incidence in both the proximal and distal colon. Colonoscopy is highly operator dependent, but systematic efforts to measure and improve quality are impacting performance. Colonoscopy holds a substantial advantage over other strategies for detection of serrated lesions, and a recent case–control study suggests that once-only colonoscopy or colonoscopy at 20-year intervals, by a high-level detector, could ensure lifetime protection from colorectal cancer for many patients

Short cap technique to complete EMR of very flat colorectal laterally spreading tumors

We demonstrate the utility of a short cap placed over the colonoscope tip to facilitate EMR of very flat portions of laterally spreading tumors (LSTs) (Fig. 1A). Snare resection is preferred over ablative techniques for the removal of very flat portions that resist snaring. Snaring of very flat portions is often frustrating because even a stiff snare may slide over the very flat tissue

Recurrence rates after EMR of large sessile serrated polyps

Background Little is known regarding the recurrence rate after EMR of large (≥20 mm) sessile serrated adenoma/polyps (SSA/Ps). Objective To compare the recurrence rate among SSA/Ps and conventional adenomas in patients referred to a specialty practice for EMR. Design Retrospective cohort study. Setting Academic hospital and a satellite surgery center. Patients A total of 362 consecutive patients referred for resection of large (≥20 mm) polyps in the colorectum. Interventions All EMRs were performed with a submucosal contrast agent. All subjects had a follow-up surveillance examination (inspection and biopsy of the EMR) at our center. Main Outcome Measurements Rates of residual polyp at follow-up examination. Results Residual polyp was identified among 8.7% of SSA/Ps compared with 11.1% for conventional adenomas (P = .8). Limitations Retrospective design, procedures performed by a single experienced endoscopist, low number of serrated lesions. Conclusions The rate of recurrence after EMR of SSA/Ps is similar to the rate after EMR of conventional adenomas

Endoscopic recognition of the sessile serrated polyp to cancer sequence

Sessile serrated polyps (SSPs), also called sessile serrated adenomas (SSAs), are the precursor lesions of 20% to 30% of colorectal cancers. The serrated polyp to cancer sequence occurs primarily in the proximal colon in the case of SSPs

Advances in CRC prevention: screening and surveillance

Colorectal cancer (CRC) is amongst the most commonly diagnosed cancers and causes of death from cancer across the world. CRC can, however, be detected in asymptomatic patients at a curable stage, and several studies have shown lower mortality among patients who undergo screening compared to those who do not. Using colonoscopy in CRC screening also results in the detection of precancerous polyps that can be directly removed during the procedure, thereby reducing the incidence of cancer. In the past decade, convincing evidence has appeared that the effectiveness of colonoscopy as CRC prevention tool is associated with the quality of the procedure. This review aims to provide an up-to-date overview of recent efforts to improve colonoscopy effectiveness of by enhancing detection and improving the completeness and safety of resection of colorectal lesions