Endoscopic resection of large colorectal polyps

Abstract

Backgrounds: endoscopic polypectomy is a common technique, but there are discrepancies over which treatment-surgical or endoscopic-to follow in case of polyps of 2 cm or larger. Objectives: to analyse the efficacy and complications of colonoscopic polypectomy of large colorectal polyps. Patients and methods: 147 polypectomies were performed on 142 patients over an eight-year period. The technique used was that of submucosal adrenaline 1:10000 or saline injection at the base of the polyp, followed by resection of the polyp using a diathermic snare in the smallest number of fragments. Remnant adenomatous tissue was fulgurated with an argon plasma coagulator. Lately, prophylactic hemoclips have been used for thick-pedicle polyps. Complete removal was defined as when a polyp was completely resected in one or more polypectomy sessions. Polypectomy failure was defined as when a polyp could not be completely resected or contained an invasive carcinoma. Results: the mean patient age was 67.9 years (range, 4-90 years), with 68 men and 79 women. There were 74 sessile polyps, and the most common location was the sigmoid colon. The most frequent histology was tubulovillous. Most of the polyps (96.6%), were resected and cured. This was not achieved in four cases of invasive carcinoma, and a villous polyp of the cecum. All pedunculated polyps were resected in one session, whereas the average number of colonoscopies for sessile polyps was 1.35 ± 0.6 (range, 1-4). The polypectomy was curative in all of the in situ carcinomata except one. As for complications, 2 colonic perforations (requiring surgery) and 8 hemorrhages appeared, which were controlled via endoscopy. There was no associated mortality. Conclusions: endoscopic polypectomy of large polyps (≥ 2 cm) is a safe, effective treatment, though it is not free from complications. Complete resection is achieved in a high percentage, and there are few relapses. It should be considered a technique of choice for this type of polyp, except in cases of invasive carcinoma.

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

“…In this study, we described a series of 1354 endoscopic resections of colon rectal polyps performed in our endoscopic units between January, 1996 and May, 2006. The gender and age distribution of patients is similar to that described above in other studies regarding the treatment of colorectal polyps [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . From the literature, it emerges that over 80% of polyps resected during colonoscopy are small polyps less than 10 mm in diameter [24] while in our study 67% were 10 mm in diameter.…”

“…The reported incidence of perforation during polypectomy of "normal-sized" polyps ranges from 0.3%-0.5% [34] , while the incidence of injury to the colon wall Brooker JC et al [3] 34 -34 17.6 0 5.9 Hsieh YH et al [4] 13 -13 0 0 0 Brooker JC et al [5] 100 -100 3 0 1 Walsh RM et al [6] 117 -117 8.5 0.8 0.8 Iishi H et al [7] 56 -56 7 0 0 Zlatanic J et al [8] 77 -77 6.5 1.3 0 Kanamori T et al [9] 33 -33 9.1 0 0 Boix J et al [10] 74 -74 13.5 0 0 Bedogni G et al [11] 66 20 42 3.1 0 1.5 Binmoeller K et al [12] 176 47 129 24 0 0 Webb WA et al [13] 102 72 30 7.8 0 0 Nivatvongs S et al [14] 280 196 84 0.7 0 1.8 Perenz RF et al [15] 147 73 74 5.4 1.3 0 Dell'Abate P et al [16] 104 49 55 3.8 0 0 Jameel JK et al [17] 30 6 24 6.1 0 0 Doniec JM et al [18] 186 45 141 15 0.5 0 Stergiou N et al [19] Table 6 Recent reports of series on large polyp endoscopic resection and our series (transmural burn, microperforation, or free perforation) in large polypectomies is 0 to 1.3% (Table 6) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . In our study, no perforation was reported in the group of large polyps while the only late perforation (0.07%) occurred, after polypectomy, in a small (15 mm) malignant sessile polyp located in the sigmoid colon and without endoscopic sign of suspected malignancy.…”

“…The incidence of bleeding during and after the polypectomies has been reported to range from 0.3% to 6.1%, with higher rates in large polyps up to 22.1% (Table 6) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . In our series, the Pearson χ 2 test applied in the subgroups found a correlation between the bleeding and liver diseases (P = 0.003), which usually impairs the coagulation function of the patients and location of polyps in transverse colon (P < 0.0001), in group 2 with histology and in particular with the hyperplastic polyps (P = 0.023) and the malignancy (P < 0.0001).…”

“…Large polyps represent a particular challenge for the endoscopist because they are often related to important risks of haemorrhage (0%-22.1%), perforation (0%-1.3%) and inadequate polypectomy [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . The alternative to endoscopic therapy of large polyps is the surgical resection which involves hospitalization and anaesthesia.…”

Colonoscopic perforations: Single center experience and review of the literature

“…Other complications are iatrogenic in nature; these include hemorrhage and perforations. Perforation rates are reported to range between 0.02% and 0.8% for diagnostic colonoscopy and between 0.15% and 0.3% for therapeutic colonoscopy (1,2). Regarding technique, endoscopic sub-mucosal dissection (ESD) is known to carry a higher perforation risk than endoscopic mucosal resection (EMR) or polypectomy (5,6).…”