Colon widefield endoscopic mucosal resection

Abstract

Colonoscopy with polypectomy is associated with a significant reduction in colorectal cancer incidence and mortality. Most polyps are small at less than 10 mm and easily managed. Large flat and sessile lesions > 20 mm, termed as advanced mucosa neoplasia (AMN), are increasingly detected and present unique therapeutic challenges. AMN > 50 mm involving greater than two third of the colonic wall circumference may be resected via wide field endoscopic mucosal resection (WF-EMR). WF-EMR is safe and effective with cost, mortality and morbidity advantages over alternative treatments. The risks of bleeding and perforation are small, but significant thus, risk stratification and early identification are essential. The techniques in WF-EMR are steadily evolving and increasingly based on high-quality multicentre studies. The fundamental steps in lesion assessment, practical aspects of resection and the management of complications are presented in this chapter.