Rectal Lesions Really Are, Well, Different
Douglas K. Rex, MD, MASGE, reviewing Cronin O, et al. Gastrointest Endosc 2022 Feb 24.
Previous studies have indicated that the rectosigmoid colon location is an independent risk factor for cancer in large nonpedunculated colorectal polyps. Surgical procedures for cancer involving the rectum have higher morbidity than colonic resections.
In this study from the Australian consortium, the features of large nonpedunculated colorectal polyps in the rectum were compared with those of colonic lesions. The median polyp size in the rectum was larger at 40 mm versus 30 mm in the colon, and rectal lesions were more likely than nonrectal lesions to be granular (79% vs 50%), nodular appearing (53% vs 17%), tubulovillous in histopathology (72% vs 47%), and cancerous (15% vs 6%).
COMMENTHigher cancer risk and greater surgical morbidity associated with adjuvant resection after piecemeal resection make endoscopic submucosal dissection a good option for patients with rectal sessile lesions and granular lesions with dominant nodules.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Cronin O, Sidhu M, Shahidi N, et al. A comparison of the morphology and histopathology of large non-pedunculated colorectal polyps in the rectum and colon: implications for endoscopic treatment. Gastrointest Endosc 2022 Feb 24. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2022.02.022)
