Invited Commentary

Commentary on "Endoscopic Mucosal Resection Recurrence Rate for Colorectal Lesions"

Authors: Patrick G. Brady, MD

Abstract

Colorectal cancer (CRC) is the second leading cause of cancer death in both men and women in the United States, and Americans have a 5% lifetime risk for this malignancy.1 With the advent of effective screening programs, primarily screening colonoscopy, the incidence and mortality of CRC has begun to decrease. This is related primarily to the detection and removal of adenomas, which are the precursor lesions of most CRCs. The majority of colonic adenomas are small pedunculated or sessile lesions that can be removed with standard polypectomy techniques using a snare or biopsy forceps; however, large (>1 cm), sessile, and flat adenomas are more difficult to remove. The challenge in removing these flat and sessile lesions is that the colonic wall is thin (5-6 mm), leaving little margin for error when applying electrosurgical techniques such as snare resection. Traditionally, many of these larger lesions were removed surgically, which increases morbidity, mortality, and cost.

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