Endoscopic Excision of Large Colorectal Polyps as a Viable Alternative to Surgical Resection

Abstract

To determine the outcome of endoscopic excision of large colorectal polyps. Design: Retrospective medical record review. Setting: Kaiser Permanente, a large health care maintenance organization. Patients: One hundred four consecutive patients with large colorectal lesions deemed not amenable to endoscopic resection at initial colonoscopy and referred for surgical resection. Intervention: Endoscopic excision under intravenous sedation by 2 interventional endoscopists. Main Outcomes Measures: Endoscopic success (the ability to completely eradicate the original or recurrent lesion endoscopically at the index procedure or at reintervention), procedure-related complications, disease recurrence, endoscopic reintervention, and surgical intervention. Results: We included 48 men (46%) and 56 women (54%) with a mean age of 67 (range, 29-92) years for analysis. Anatomic distribution of the lesions included the colon (68%) and rectum (32%). Thirty-nine patients (37%) had carcinoma. The median size of the lesions was 3.0 (range, 1-9) cm. The endoscopic success rate was 83% and was highest in patients with noncarcinoma histologic findings compared with carcinoma (PϽ.001). The morbidity rate was 7%, and all complications occurred in the ascending colon (P=.06). Endoscopic reintervention occurred in 25 of 92 patients (27%). Surgical intervention was undertaken in 14% of all patients. During a mean follow-up of 14 (median, 12) months, recurrent disease was noted in 10 of 86 patients (12%) and occurred more frequently in rectal lesions (P = .002). All recurrences were eradicated endoscopically. Conclusions: Endoscopic excision of large colorectal polyps is a viable alternative to surgical resection in a select group of patients and can be performed safely with a good success rate.

Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis

“…1) [19, 21 -24] and assessed for relevance (see Table e1, available online). Of these studies, a total of 12 were excluded, either because no separate assessment of recurrences was made for nonpedunculated vs. pedunculated lesions [21 -25], deep submucosal lesions vs. non-or minimally invasive lesions [24 -27] or en bloc vs. piecemeal resections [21 -31], or because submucosal fluid injection was not reported to be used for more than 80 % of resections [27,31,32]. One study reported no separate recurrence rates for en bloc and piecemeal resections but instead provided the ratio of en bloc and piecemeal lesions at follow-up [33].…”

“…26 Malignant lesions, not otherwise specified. 27 Only the sessile polyps of this study were evaluated. 28 Separate analysis was only available for the sessile lesions that were removed by piecemeal resection.…”

Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: A systematic review

“…EMR has been extensively used throughout the gastrointestinal tract to remove early neoplastic lesions; it is widely accepted for the treatment of colon adenomas and superficial colorectal tumors (Swan et al, 2009;Bergmann and Beger, 2003;Su et al, 2005;Bories et al, 2006;Katsinelos et al, 2006;Arebi et al, 2007;Hurlstone et al, 2008;Urban et al, 2008;Mahadeva and Rembacken, 2009;Luigiano et al, 2009;Huang et al, 2009;Lim et al, 2010;Ferrara et al, 2010;Conio et al, 2010a;Saito et al, 2010a;Toyonaga et al, 2010;Hochdörffer et al, 2010;Moss et al, 2011;Kao et al, 2011;Tajika et al, 2011;Santos et al, 2011;Mannath et al, 2011;Kim et al, 2012;Lee et al, 2012;Kobayashi et al, 2012;Fasoulas et al, 2012;Buchner et al, 2012;Binmoeller et al, 2012;Terasaki et al, 2012;Carvalho et al, 2013;Kim et al, 2013;Masci et al, 2013;Dior et al, 2013;Cipolletta et al, 2014;Maguire and Shellito, 2014;Gómez et al, 2014;Grgov et al, 2014;Belle et al, 2014;Knabe et al, 2014;Wang et al, 2014a;…”

In Vivo Endoscopic Tissue Identification by Rapid Evaporative Ionization Mass Spectrometry (REIMS)

“…[4] However,u pt o7 .8 %ofu pper-GI cancers may be missed by this technique in patients who are subsequently diagnosed with cancer. [8] Hence,t here remains an eed to develop accurate in situ techniques for improving the adenoma detection rate (ADR) and for real-time chemical biopsies that can detect dysplasia or cancer in vivo to increase the efficacy and safety of endoscopic therapies.Enhanced endoscopic imaging technologies are currently being developed to address these requirements,with aspecific emphasis on spectroscopic characterization using elastic scattering spectroscopy,o ptical coherence tomography,a nd multimodal imaging combining Raman spectroscopy,a utofluorescence,a nd narrow band imaging. [6] Amajor advantage of endoscopic intervention is that it provides al ess invasive therapeutic option compared to conventional open surgical approaches.Early-stage cancers and premalignant conditions are now routinely treated using endoscopic mucosal resection (EMR) techniques that utilize electrosurgical diathermy and radiofrequencyablation (RFA).…”