This unresolved debate confuses the choice of the optimal treatment for complex rectal polyps. The sharp increase in endoscopic resection of rectal polyps made the indications for TEM questioned. Then, the use of endoscopic electrosurgical knives made it possible to achieve en bloc resection, known as Endoscopic Submucosal Dissection (ESD). First, large piecemeal snare ablations were reported. However, in the late nineties, endoscopy was advocated as a diagnostic technique and a therapeutic method. It soon became apparent that indications to TEM could be successfully extended to early malignant polyps. This revolutionary technique enabled superficial or full-thickness excision of large adenomatous lesions. He conceived a novel endoscopic technology to facilitate the excision of rectal polyps through the anus. With the aim to reduce morbidity and mortality of rectal surgery, in 1983, Gerhard Buess introduced Transanal Endoscopic Microsurgery (TEM). The introduction of endoscopic screening programs has probably contributed to the improved detection of rectal polyps and early malignant lesions. The incidence of rectal polyps has steadily increased in recent decades and will continue to rise.
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