Endoscopic diagnosis and therapy of colorectal neoplasia

Early detection and removal of colorectal adenomas can reduce the mortality from and incidence of colorectal cancer (CRC). The reliable detection and resection of adenomas plays an important role in CRC screening. The development of high-definition television and magnifying endoscopy has provided a new level of imaging quality for detecting neoplastic lesions. With additional chromoendoscopy and narrow band imaging, a certain discrimination between neoplastic and nonneoplastic lesions seems possible. T1 colorectal cancer resection can be performed endoscopically by endoscopic mucosa re-section or endoscopic submucosal dissection (ESD). The advantage of ESD is that a precise histopathologic assessment can be made from the en bloc resected specimen. In a palliative situation, the implantation of self-expanding metal stents is an effective and safe therapy for noncurable obstructive colorectal cancer, especially in older patients with comorbidity.