ASCRS Ch05 — Endoscopic Management of Polyps and Endolumenal Surgery

Citation: Johnston WF, Gorgun E. "Endoscopic Management of Polyps and Endolumenal Surgery." In: Steele SR, et al. (eds.), The ASCRS Textbook of Colon and Rectal Surgery, 4th ed. Springer Nature Switzerland AG; 2022. pp. 79–93 (PDF pp. 94–108 of the combined textbook file). Source file: raw/ASCRS Textbook 4th Ed.pdf (full 1,198-page textbook; cite by page range within the single PDF).

Type: Specialty textbook chapter (reference/background, not primary literature).

Scope

Fifth chapter of the sequential full-textbook ingest (see ASCRS Ch01 - Anatomy and Embryology for the ingest's scope/plan). Covers forceps and snare polypectomy technique, submucosal lifting, endoscopic mucosal resection (EMR, including underwater EMR and selective clip use), endoscopic submucosal dissection (ESD — complications, patient selection via Paris/NICE classification and the non-lifting sign, technique, postoperative care, and the ESD-vs-EMR controversy), endoscopic suturing, stabilization platforms, the referral pathway for endoscopically "unresectable" polyps, and colonic stenting (bridge-to-surgery vs. palliative indications, technique, and anastomotic-leak stenting).

Key content

Full synthesis written into the new procedure page Endoscopic Polypectomy, EMR & ESD rather than summarized twice here. Directly extends/trims Local Excision of Rectal Neoplasms's prior brief EMR/ESD mention, and fills previously flagged gaps on two existing condition pages: Large Bowel Obstruction ("endoscopic stent outcomes/ complication rates not covered") and Obstructing Colon Cancer ("no comparative stenting-vs-surgery data" — refined to note the specific ESGE 2014 guideline and its risk-stratified recommendation).

Limitations

• Textbook chapter, not primary literature; cites but does not independently verify most of the trial/series figures given for polypectomy technique comparisons, EMR/ESD recurrence rates, and stenting outcomes.
• One specific claim (extrinsic-cause colonic stenting having worse outcomes than intrinsic-lesion stenting) is explicitly sourced to the chapter authors' personal experience rather than a cited study — flagged as lower-strength within the new page.
• The peritoneal-tumor-seeding-after-ESD-perforation figure (9%) is drawn from gastric-ESD literature and extrapolated to colon by the chapter authors, not colon-specific data.

Relevance

Fifth entry in the ASCRS ingest, and the second consecutive technique-focused chapter (following Ch. 4's general endoscopy chapter). Creates Endoscopic Polypectomy, EMR & ESD, meaningfully trims duplication on Local Excision of Rectal Neoplasms, and fills two previously-flagged open-item gaps on Large Bowel Obstruction and Obstructing Colon Cancer with specific numeric outcomes and a named guideline — a good example of a later chapter directly resolving earlier ingest gaps.