New chapter in precision medicine: strategies for endoscopic resection of 10-20 mm non-pedunculated colorectal polyps.

Abstract

The preferred resection methods for 10-20 mm non-pedunculated lesions remain unclear. This review summarizes the current methods and novel technologies for resecting 10-20 mm non-pedunculated colorectal polyps, mainly focusing on hot snare polypectomy, cold snare polypectomy (CSP), endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD). The application of novel techniques involving bipolar snares and low-power pure-cut is expected to reduce adverse events (AEs) related to thermal damage, but prospective studies are needed to confirm their reliability. CSP, including conventional CSP and submucosal injection CSP (SI-CSP), maintains resection efficacy with dedicated snares or submucosal injection for regular non-pedunculated polyps and serrated lesions with a low AE rate of 0.0%-3.4%. Modified EMR techniques such as underwater EMR, tip-in EMR, and EMR-circumferential precutting demonstrate a 15.0%-20.0% increase in en bloc resection rates compared with conventional EMR while also reducing AEs. ESD is recommended as the preferred method for medium-sized colorectal lesions with suspected submucosal invasion, fibrosis, particularly when the procedure is technically challenging. In addition, optical diagnosis is essential for pathological assessment and precise resection. Also, postoperative follow-up is needed for high-risk lesions and cases with unsatisfactory resection.