Efficacy, Safety and Outcomes of ‘Inject and Cut’ Endoscopic Mucosal Resection for Large Sessile and Flat Colorectal Polyps

Abstract

Background and Study Aims: The study examines the outcomes of the ‘inject and cut’ endoscopic mucosal resection (EMR), for large sessile and flat colorectal polyps. Patients and Methods: Between January 2006 and December 2008 all patients referred to our institution for EMR of large polyps were prospectively evaluated. The accuracy of lifting sign and the rate of en bloc and piecemeal resection, complications and recurrence were analyzed. Results: A total of 157 patients with 182 lesions (median size 24.7 ± 10.2 mm) were included in the study. The most frequent location was the sigmoid colon in 30.2%. Because of non-lifting sign, 5/182 lesions were referred to surgical resection and 177 (43 flat and 134 sessile) were resected, 79 (44.6%) en bloc and 98 (55.4%) piecemeal. There were 20 procedural (11.3%) and 2 late (1.1%) bleeding, 4 post-polypectomy syndrome (2.2%) and 2 perforations (1.1%). Bleeding was related to malignancy (p = 0.01). Intramucosal cancer was observed in 5 cases (2.8%) while invasive cancer was seen in 8 (4.5%). Malignancy was related to polyp size ≧30 mm (p = 0.002). Follow-up colonoscopy was performed in 147 patients with 172 EMR for a mean of 19.8 months. Recurrence was observed in 12/172 (6.9%) polyps. Conclusion: Inject and cut EMR is practical and effective with a low risk of complication and local recurrence.

Endoscopic mucosal resection in colorectal lesion: a safe and effective procedure even in lesions larger than 2 cm and in carcinomas

“…Most series have reported a higher recurrence rate associated with piecemeal resection as compared to en bloc resection (11,31,33) . Although our findings are consistent with most previous studies, Lim et al (30) found no difference between the two techniques.…”

Selective tissue elevation by pressure for endoscopic mucosal resection of colorectal adenoma: first clinical trial

“…Bleeding is one of the most commonly reported complications of colonic EMR, with bleeding rates of 1-24% [4,5,[16][17][18]. Our reported intraprocedural bleeding rate of 34% was higher.…”

“…No perforation required surgical intervention. Conclusion This first clinical trial to analyze STEP technique demonstrated that STEP used to elevate large mucosal lesions in any location is feasible and facilitates EMR for colorectal adenoma.Keywords Adenoma Á Endoscopic mucosal resection Á High pressure water jet Á Hydrojet Á Needleless injection and elevation Á Selective submucosal fluid cushion Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are the established standard procedures for the treating mucosal neoplasms of the gastrointestinal tract [1][2][3][4][5][6][7]. The intention of the EMR and ESD techniques is to achieve an oncologically sufficient procedure with a minimally invasive concept.…”

Endoscopic Resection Techniques

“…Injection of adequate amounts of submucosal fluid is of paramount importance to avoid perforations in the colon, especially in right-sided lesions. A recent series of colonic EMR in 182 lesions showed a perforation rate of 1% and bleeding in 12% of the cases [84]. Bleeding rates after EMR of large colonic polyps range from 2 to 11% [85].…”