Endoscopic polypectomy: techniques, complications and follow-up

Abstract

Colorectal cancer is one of the most common cancers in developed countries. Increasing numbers of early stage colorectal cancers and precancerous adenomatous lesions, polypoidal type lesions, and flat and depressed type lesions can be visualised and treated endoscopically thanks to endoscopic ultrasonography, high magnification chromoendoscopy and other technical advances. Polypectomy is generally considered for protuberant lesions, with both sessile and pedunculate morphology, and endoscopic mucosal resection (EMR) is indicated for superficial, flat or depressed types of lesions. Endoscopic therapy for colonic adenoma with dysplasia and early colorectal cancer is more advantageous than the conventional operative treatment, in that it is a relatively non-invasive and less costly method. However, endoscopic therapy is completely ineffective in lesions with lymph node or distant metastasis. Therefore, it is becoming more and more important to understand the correct indications and limitations of endoscopic polypectomy/mucosectomy as well as complication rates and the correct follow-up schedule.

Análise dos pólipos colorretais em 3.491 videocolonoscopias

“…Hemorragia, perfuração intestinal, polipectomia inadequada e o não reconhecimento de um câncer são complicações e dificuldades que podem ocorrer na colonoscopia, com prevalências descritas por Church 20 variando de 1 a 9%, dependendo da experiência do examinador 12,6,9,18,20,33 . Winawer e Markowitz 18 descreveram taxas de perfuração ou grandes sangramentos de 0,1 a 0,2% dos exames, Waye et al .9 relataram índices de menos de 1% de perfuração e 0,27 a 2,21% de sangramento, enquanto Repici e Tricerri 33 apontaram sangramento em 0,3 a 6,1% das colonoscopias.…”

Efficacy, risk factors and complications of endoscopic polypectomy: Ten year experience at a single center

“…The most common complications after polypectomy are bleeding (from 0.3% to 6.1%) and pain due either to excessive gas accumulation or to parietal damage and perforation after current www.wjgnet.com application [2] . Frequently, these complications follow large polyps polypectomies.…”

Subacute reaction to endoscopic mucosal resection mimicking perforation

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

“…[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. 2 The risks of these complications are thought to increase with the size of polyp being excised.…”

“…2 The risks of these complications are thought to increase with the size of polyp being excised. [1][2][3] An unusual complication of endoscopic polypectomy is post-polypectomy electrocoagulation syndrome. 1 Patients present at 12-120 hours after endoscopy with pain, fever, leucocytosis and peritoneal inflammation in the absence of frank perforation.…”