Digestive Disease Interventions 2023; 07(01): 010-016
DOI: 10.1055/s-0043-1760732
Review Article

Endoluminal Surgery and Next Steps

1   Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
1   Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations


The expansion of colorectal cancer screening programs predicts a remarkable increase in rectal cancer diagnosis and nonmalignant polyps. While most polyps are managed endoscopically, many patients are referred to surgery. Over 30 thousand patients with colon polyps undergo surgical resection annually in the United States. Most of these surgical resections typically report benign pathology but end up with organ loss. Such organ resections may enclose significant morbidity and mortality rates. On the other hand, advanced endoscopic interventions have significantly evolved and are gaining popularity due to claiming organ preservation with low morbidity and mortality. These procedures have the potential to develop further and, in no doubt, are becoming standard of care. There are recent articles reporting successful and feasible initial incorporation of robotic systems for submucosal dissection procedures. These developments confirm that endorobotic submucosal dissection and endorobotic surgery may soon become a reality for colorectal lesions. This article aims to discuss endoluminal surgery for colorectal lesions and future directions.

Publication History

Received: 28 June 2022

Accepted: 08 December 2022

Article published online:
25 January 2023

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  • References

  • 1 White A, Joseph D, Rim SH, Johnson CJ, Coleman MP, Allemani C. Colon cancer survival in the United States by race and stage (2001-2009): findings from the CONCORD-2 study. Cancer 2017; 123 (Suppl. 24) 5014-5036
  • 2 Zauber AG, Winawer SJ, O'Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366 (08) 687-696
  • 3 Davidson KW, Barry MJ, Mangione CM. et al; US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 325 (19) 1965-1977
  • 4 Peery AF, Cools KS, Strassle PD. et al. Increasing rates of surgery for patients with nonmalignant colorectal polyps in the United States. Gastroenterology 2018; 154 (05) 1352-1360.e3
  • 5 Ozgur I, Liska D, Cengiz TB. et al. Colectomy for polyps is associated with high risk for complications and low risk for malignancy: time for endoluminal surgery?. Am J Surg 2022; 223 (03) 463-467
  • 6 Gorgun E, Benlice C, Abbas MA, Steele S. Experience in colon sparing surgery in North America: advanced endoscopic approaches for complex colorectal lesions. Surg Endosc 2018; 32 (07) 3114-3121
  • 7 Kaltenbach T, Anderson JC, Burke CA. et al. Endoscopic removal of colorectal lesions-recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2020; 158 (04) 1095-1129
  • 8 Tanaka S, Kashida H, Saito Y. et al. Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2020; 32 (02) 219-239
  • 9 Klein A, Bourke MJ. Advanced polypectomy and resection techniques. Gastrointest Endosc Clin N Am 2015; 25 (02) 303-333
  • 10 Repici A, Hassan C, De Paula Pessoa D. et al. Efficacy and safety of endoscopic submucosal dissection for colorectal neoplasia: a systematic review. Endoscopy 2012; 44 (02) 137-150
  • 11 Saito Y, Uraoka T, Yamaguchi Y. et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 2010; 72 (06) 1217-1225
  • 12 Hayashi N, Tanaka S, Hewett DG. et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. Gastrointest Endosc 2013; 78 (04) 625-632
  • 13 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58 (6, Suppl): S3-S43
  • 14 Kudo S, Tamura S, Nakajima T, Yamano H, Kusaka H, Watanabe H. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 1996; 44 (01) 8-14
  • 15 Sapci I, Gorgun E. Endoscopic submucosal dissection. In: Bardakcioglu O. ed. Advanced Techniques in Minimally Invasive and Robotic Colorectal Surgery. Springer; 2019: 9-16
  • 16 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47 (09) 829-854
  • 17 Gupta S, Lieberman D, Anderson JC. et al. Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2020; 115 (03) 415-434