Endoscopic management of large colorectal polyps

Iambrenghi, Onofrio Caputi; Ugenti, Ippazio; Martines, Gennaro; Marino, F.; Altomare, D. F.; Memeo, V.

doi:10.1007/s00384-009-0684-4

Cited by 29 publications

(21 citation statements)

References 25 publications

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“…Perforation has been reported as occurring in 0% to 4% of cases (3,15,18,22) . Caputi et al (5) reported in their series 2.3% of perforation after EMR (all polypoid carcinomas). Swan et al (45) described a target sign as a marker of muscularis propria resection and, therefore, potential perforation during EMR of colorectal lesions, with an incidence of 3.8% for en bloc resection and 1.6% for piecemeal resection (P = 0.16).…”

Section: Discussionmentioning

confidence: 86%

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: 86%

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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“…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. 13 These are significant incidences for serious complications. EMR at colonoscopy cannot therefore be considered to be a procedure without risk, particularly for large polyps and in situations with difficult access.…”

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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“…[1][2][3][4] The polyps are snared or removed with diathermy, either en bloc or in a piecemeal fashion.…”

mentioning

confidence: 99%

“…Complications of EMR are less frequent than for standard endoscopic polypectomy. [1][2][3][4][5] The most common adverse event is bleeding (which can be immediate or delayed) and significant bleeding occurs in up to 6.1% of patients. 1 Perforation is uncommon, occurring in 4% of patients, and is suspected in patients complaining of severe abdominal pain not relieved by passing flatus.…”

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Subacute reaction to endoscopic mucosal resection mimicking perforation

Williamson

Dunkley

Hewin

2012

annals

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A 25-year-old woman underwent routine day-case endoscopic mucosal resection (EMR) of two ascending colonic polyps. Six hours later she re-presented with severe abdominal pain. On examination she was tachycardic with tenderness and peritonism in the right lower quadrant. Urgent abdominal computed tomography (CT) did not reveal any signs of free intra-abdominal gas or fluid but did detect transmural thickening and oedema in the ascending colon and caecum. As there was no radiological evidence of perforation, the patient was managed conservatively and made a full recovery.The exact aetiology of this patient's symptoms is not known. She may have developed post-polypectomy electrocoagulation (a transmural diathermy injury), localised ischaemia of the colonic wall (secondary to the adrenaline used during EMR) or an allergic reaction to the dye used during EMR.As EMR is an increasingly used treatment modality in the management of colonic polyps, clinicians should have an awareness of the complications of treatment. We would advocate a low threshold for prompt CT investigation in any patient presenting with abdominal pain after EMR to detect any evidence of free intraperitoneal air. Patients without signs of perforation may be managed conservatively, as in this case.

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Endoscopic management of large colorectal polyps

Abstract: EP is relatively safe and effective for benign-appearing LCPs.

Cited by 29 publications

References 25 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

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

Subacute reaction to endoscopic mucosal resection mimicking perforation

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