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Early gastrointestinal cancers or T1 cancers are limited to the mucosa or the submucosa. Virtually all of these tumors are eligible to a complete endoscopic resection by endoscopic mucosal resection or submucosal dissection, allowing avoiding upfront surgical resection. However, endoscopic technical difficulties or uncertainties in endoscopic histological prediction can lead to histologically incomplete resections, requiring salvage treatment. Other tumors, although entirely resected, are considered to have a significant risk of metastasis, warranting adjuvant therapy, depending on histological criteria on the resection specimen. The management of these lesions needs to take into account several parameters, among which the patient comorbid conditions, wishes, endoscopic resection modality, lesion location, qualitative and quantitative histological criteria. This is the role of a multidisciplinary tumor board dedicated to early gastrointestinal cancers. Involving gastrointestinal endoscopists, oncologists, digestive surgeons, pathologists, radiation oncologists and radiologists, its aims at stating the curative nature of the endoscopic resection procedure, or indicating additional treatments. [ABSTRACT FROM AUTHOR]

After wide-spreading of carbon dioxid use in endoscopy, underwater procedures are the next big step for the endoscopic technical improvement. In the field of diagnosis, water-assisted colonoscopy is associated with best patient reported outcomes such as pain, but also with higher quality criteria such as cæcal intubation rate, bowel cleanliness and adenoma detection rates. Despite its need for a longer examination duration, water-exchange colonoscopy should be preferred to water-immersion colonoscopy. The better tolerance of water-assisted colonoscopy with excellent outcomes should lead to more examinations without general anesthesia, allowing quicker care for patients. Underwater mucosal resection is a technique of choice, especially for sessile or flat lesions, without prior submucosal injection, providing a distance between the muscular layer and the lesion thanks to flotation effect and the minimal distension of the colonic wall during immersion. Underwater mucosal resection improves the en-bloc resection rate and complete resection rate compared to conventional mucosal resection without increasing the adverse event rate, in particular perforation. This strategy is also feasible and safe in the duodenum. Underwater techniques also reduce the environmental footprint since fewer devices are needed and bacteriological mastered water can be used. [ABSTRACT FROM AUTHOR]

Résumé: Les techniques de résection endoscopique représentent l'exemple le plus caractéristique du basculement de l'endoscopie d'un champ diagnostique vers un champ thérapeutique. La polypectomie, la mucosectomie et la dissection sous-muqueuse ont désormais une place bien définie dépendant du type de lésion et du risque de dégénérescence pouvant être prédit à l'aide des techniques de chromoendoscopie dont la maîtrise est un prérequis indispensable avant de se lancer dans ces procédures thérapeutiques. Toutes ces techniques de résection endoscopique ont une efficacité carcinologique comparable à la chirurgie lorsque les critères de curabilité anatomopathologique sont respectés. La morbidité très inférieure de ces gestes endoscopiques par rapport à leur alternative chirurgicale doit imposer une prise en charge endoscopique première de ces lésions. Une formation des personnels médicaux et paramédicaux et un matériel adapté sont nécessaires dans les structures réalisant le dépistage du cancer du côlon pour améliorer la prise en charge des patients et diminuer l'incidence et la mortalité du cancer du côlon. Les progrès des méthodes diagnostiques et des traitements oncologiques pourraient étendre encore le champ des techniques de résection endoscopique pour les tumeurs superficielles du tube digestif. Endoscopic resection techniques represent the most characteristic example of the switch from endoscopy of a diagnostic field to a therapeutic field. Polypectomy, Endoscopic mucosal resection and endoscopic submucosal dissection have now a definite place depending on the type of lesion and the risk of cancer that can be predicted using chromoendoscopy techniques whose mastery is a prerequisite before performing this skilled procedures. All these techniques of endoscopic resection have a carcinologic efficacy comparable to surgery when the curability criteria are respected. The very inferior morbidity of these endoscopic procedures compared to their surgical alternative must impose a first endoscopic management of these lesions. Training of medical and paramedical staff and appropriate equipment are required in facilities performing colon cancer screening to improve patient management and reduce the incidence and mortality of colon cancer. Advances in diagnostic methods and oncological treatments may further extend the field of endoscopic resection techniques for superficial tumors of the digestive tract. [ABSTRACT FROM AUTHOR]

Non-ampullar duodenal sporadic adenomas are rarely found during upper digestive endoscopy. The prevalence is evaluated between 1 to 3 cases per 1,000 patients. The potential risk of degeneration appears to be less important than that of colonic adenoma with a longer duration of evolution. Two risk factors for transformation were identified: size >2 cm and high grade dysplasia. Duodenal sporadic adenomas are associated with a higher incidence of colon adenomas and adenocarcinomas. The place of the biopsies before treatment remains controversial because the biopsies may induce a submucosal fibrosis which will hinder the endoscopic resection later. Endoscopic resection should be monobloc with sufficient margins for an unquestionable anatomo-pathological study (lateral margins, depth, intra-mucosal invasion). The decision of the most appropriate treatment should be discussed at a multidisciplinary meeting. Duodenal polypectomy exposes to a high risk of haemorrhage and perforation. The prevention of delayed haemorrhage by the insertion of a clip is essential. [ABSTRACT FROM AUTHOR]

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Copyright of Colon & Rectum is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Competing Interests: Disclosure The authors report no conflicts of interest in this work.