OBJECTIVE: Large sessile or flat colorectal polyps, which are traditionally treated surgically, may be amenable to endoscopic mucosal resection (EMR), often using a piecemeal method. Appropriate selection of lesions and a careful technique may enhance the efficacy of EMR for polyps >or=20 mm in diameter without compromising safety. The aim of this study was to identify the factors that may be predictive of the risk of polyp recurrence. MATERIAL AND METHODS: A retrospective analysis was conducted on the outcome of 161 polyps >or=20 mm in diameter, treated by piecemeal EMR at a single centre using the "lift and cut" technique. All records were reviewed for polyp size, site, morphology and histology. Polypectomy technique, patient follow-up, polyp recurrence and surgical interventions were also recorded. RESULTS: Over an 8-year period, 161 colonic polyps measuring >or=20 mm were removed by EMR. Follow-up data were available for 149 cases (93%) with a mean polyp diameter of 32.5 mm; the total success rate of endoscopic polyp removal was 95.4%. The number of cases requiring 1, 2, 3, 4 and 6 attempts at EMR was 89 (60%), 36 (24%), 14 (9%), 2 (1.3%) and 1 (0.7%), respectively. Recurrence was significantly related to polyp size (p<0.001). There was no statistically significant relationship between site and recurrence. Seven patients (4.6%) underwent surgical intervention after EMR because of failed clearance. There were no post-EMR perforations and significant bleeding was reported in only two patients (1.7%). CONCLUSIONS: With careful attention to technique, piecemeal EMR is a safe option for the resection of most sessile and flat colorectal polyps >or=20 mm in size. A stricter follow-up may be required for larger lesions because of a higher risk of recurrence.
OBJECTIVE: Large sessile or flat colorectal polyps, which are traditionally treated surgically, may be amenable to endoscopic mucosal resection (EMR), often using a piecemeal method. Appropriate selection of lesions and a careful technique may enhance the efficacy of EMR for polyps >or=20 mm in diameter without compromising safety. The aim of this study was to identify the factors that may be predictive of the risk of polyp recurrence. MATERIAL AND METHODS: A retrospective analysis was conducted on the outcome of 161 polyps >or=20 mm in diameter, treated by piecemeal EMR at a single centre using the "lift and cut" technique. All records were reviewed for polyp size, site, morphology and histology. Polypectomy technique, patient follow-up, polyp recurrence and surgical interventions were also recorded. RESULTS: Over an 8-year period, 161 colonic polyps measuring >or=20 mm were removed by EMR. Follow-up data were available for 149 cases (93%) with a mean polyp diameter of 32.5 mm; the total success rate of endoscopic polyp removal was 95.4%. The number of cases requiring 1, 2, 3, 4 and 6 attempts at EMR was 89 (60%), 36 (24%), 14 (9%), 2 (1.3%) and 1 (0.7%), respectively. Recurrence was significantly related to polyp size (p<0.001). There was no statistically significant relationship between site and recurrence. Seven patients (4.6%) underwent surgical intervention after EMR because of failed clearance. There were no post-EMR perforations and significant bleeding was reported in only two patients (1.7%). CONCLUSIONS: With careful attention to technique, piecemeal EMR is a safe option for the resection of most sessile and flat colorectal polyps >or=20 mm in size. A stricter follow-up may be required for larger lesions because of a higher risk of recurrence.
Authors: Teegan R Lim; Venkat Mahesh; Salil Singh; Benjamin H L Tan; Mohamed Elsadig; Nerukav Radhakrishnan; Phil Conlong; Chris Babbs; Regi George Journal: World J Gastroenterol Date: 2010-11-14 Impact factor: 5.742
Authors: Scott R Steele; Eric K Johnson; Bradley Champagne; Brad Davis; Sang Lee; David Rivadeneira; Howard Ross; Dana A Hayden; Justin A Maykel Journal: World J Gastroenterol Date: 2013-07-21 Impact factor: 5.742
Authors: Heiko Pohl; Ian S Grimm; Matthew T Moyer; Muhammad K Hasan; Douglas Pleskow; B Joseph Elmunzer; Mouen A Khashab; Omid Sanaei; Firas H Al-Kawas; Stuart R Gordon; Abraham Mathew; John M Levenick; Harry R Aslanian; Fadi Antaki; Daniel von Renteln; Seth D Crockett; Amit Rastogi; Jeffrey A Gill; Ryan J Law; Pooja A Elias; Maria Pellise; Michael B Wallace; Todd A Mackenzie; Douglas K Rex Journal: Gastroenterology Date: 2019-03-15 Impact factor: 22.682