EMR of large sessile colorectal polyps

Conio, Mássimo; Repici, Alessandro; Demarquay, Jean François; Blanchi, Sabrina; Dumas, R.; Filiberti, Rosangela

doi:10.1016/s0016-5107(04)01567-6

Cited by 199 publications

(142 citation statements)

References 34 publications

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“…Seo et al (42) showed a higher recurrence rate after piecemeal resection for malignant polyps (33.3%) than for benign polyps (3.1%) (P<0.05). Conio et al (6) noted similar recurrence rates. However, conflicting data exist concerning the use of argon plasma coagulation as an adjunct to piecemeal resection to reduce recurrence of neoplasms (4,14,33,54) .…”

Section: Discussionmentioning

confidence: 79%

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

Santos¹,

Malaman²,

Pereira-Lima

2011

Arq. Gastroenterol.

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-Context -Endoscopic mucosal resection is a minimally invasive technique used in the treatment of colorectal neoplasms, including early carcinomas of different size and morphology. Objectives -To evaluate procedure safety, efficacy, outcomes, and recurrence rate in endoscopic mucosal resection of colorectal lesions. Methods -A total of 172 lesions in 156 patients were analyzed between May 2003 and May 2009. All lesions showed pit pattern suggestive of neoplasia (Kudo types III-V) at high-magnification chromocolonoscopy with indigo carmine. The lesions were evaluated for macroscopic classification, size, location, and histopathology. Lesions 20 mm or smaller were resected en bloc and lesions larger than 20 mm were removed using the piecemeal technique.Complications and recurrence were analyzed. Patients were followed up for 18 months. Results -There were 83 (48.2%) superficial lesions, 57 (33.1%) depressed lesions, 44 (25.6%) laterally spreading tumors, and 45 (26.2%) protruding lesions. Mean lesion size was 11.5 mm ± 9.6 mm (2 mm-60 mm). Patients' mean age was 61.6 ± 12.5 years (34-93 years). Regarding lesion site, 24 (14.0%) lesions were located in the rectum, 68 (39.5%) in the left colon, and 80 (46.5%) in the right colon (transverse, ascending, and cecum). There were 167 (97.1%) neoplasms: 142 (82.5%) adenomatous lesions, 24 (14.0%) intramucosal carcinomas, and 1 (0.6%) invasive carcinoma. En bloc resection was performed in 158 (91.9%) cases and piecemeal resection in 14 (8.1%). Bleeding occurred in 5 (2.9%) cases. Recurrence was observed in 4.1% (5/122) of cases and was associated with lesions larger than 20 mm (P<0.01), piecemeal resection (P<0.01), advanced neoplasm (P = 0.01), and carcinoma compared to adenoma (P = 0.04). Conclusions -Endoscopic mucosal resection of colorectal lesions is a safe and effective procedure, with low complication and local recurrence rates. Recurrence is associated with lesions larger than 20 mm and carcinomas.

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Section: Discussionmentioning

confidence: 79%

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

Santos¹,

Malaman²,

Pereira-Lima

2011

Arq. Gastroenterol.

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“…41 Besides, a study from Italy reported that EMR was performed for 139 SP in 136 patients by snare polypectomy, and invasive carcinoma was found in 17 cases. 42 After 12 months of follow up after EMR, no local recurrence was detected in 7 patients with invasive carcinoma without surgery. Another study from UK reported on 30 large colorectal polyps which were treated by en bloc resection in 22 cases and by piecemeal resection in 8 cases.…”

Section: Colorectummentioning

confidence: 86%

Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection as Treatments for Early Gastrointestinal Cancers in Western Countries

Coda¹,

Lee²,

Gotoda³

2007

Gut Liver

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“…There are reports of large right-sided sessile polyps being removed endoscopically. 10,11 However, the overall frequency of colonic perforation for polypectomy has been estimated to be about 1 in 200. 12 Furthermore, one study advocating EMR at colonoscopy for large colorectal polyps reported on a series of 151 polyps undergoing EMR with 3 perforations and 2 cases of copious haemorrhage requiring emergency bowel resection.…”

Section: Discussionmentioning

confidence: 99%

Laparo-endoscopic resection for extensive and inaccessible colorectal polyps: a feasible and safe procedure

Wood

Lord

Wheeler

et al. 2011

annals

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INTRODUCTION Polypectomy at colonoscopy may be difficult or dangerous. In such instances colonic resection may be indicated. Novel combined laparoscopic-endoscopic procedures have the potential to allow safe extensive extramucosal resection, thus avoiding resection. Laparoscopic colon mobilisation provides a more favourable orientation for endoscopic mucosal resection and facilitates identification of possible perforation sites with immediate laparoscopic repair or resection if necessary. This study aimed to assess the efficacy and safety of laparo-endoscopic resection (LER) of colonic polyps. PATIENTS AND METHODS Data were collected prospectively on consecutive patients undergoing LER. The mode of presentation, referral pattern, lesion site and size, hospital stay, procedural details, complications, histology and further treatment were recorded. RESULTS A total of 13 patients underwent attempted LER (16 polyps in total) and this was completed for 10, with a median hospital stay of 2 days. Five polyps were removed whole and eight piecemeal. Excision was clinically complete in all cases. Three procedures were converted to colonic resection. One lesion appeared malignant, indicating a conversion to laparoscopic right hemicolectomy. Two polyps were not amenable to LER and resection was performed. One patient underwent subsequent colonic resection based on the histological findings. There were no perforations or serious complications. CONCLUSIONS LER is a safe and effective treatment for large and inaccessible colonic polyps that would otherwise be treated by colonic resection.

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EMR of large sessile colorectal polyps

Cited by 199 publications

References 34 publications

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

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

Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection as Treatments for Early Gastrointestinal Cancers in Western Countries

Laparo-endoscopic resection for extensive and inaccessible colorectal polyps: a feasible and safe procedure

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