Update on the endoscopic management of colonic neoplasia – how endoscopy is replacing surgery

Segmental colon resection has traditionally been the treatment of choice for colonic neoplasia. However, surgery can be associated with significant short- and long-term morbidity and mortality that may not be acceptable for patients with either early or very late stage disease. Several systems for endoscopically assessing the risk of submucosal involvement with a high degree of sensitivity and specificity are now available. Appropriately selected lesions with low risk for lymph node involvement can be identified and managed with advanced endoscopic techniques such as endoscopic mucosal resection and endoscopic submucosal dissection. The indications, techniques, and complications of endoscopic mucosal resection and endoscopic submucosal dissection are described. In addition, we discuss new devices which have been designed to shorten the learning curve and increase the safety of these techniques. Finally, we review the use of self-expanding metal stents (SEMS) for management of advanced tumors.