Joshua Sommovilla1, David Liska, James Church. 1. Sanford R. Weiss M.D. Center for Hereditary Colorectal Neoplasia, Cleveland Clinic Foundation, Cleveland, Ohio.
Abstract
INTRODUCTION: When patients with familial adenomatous polyposis have a severely affected rectum it is usually assumed that endoscopic control is impossible or unwise. The standard approach is proctectomy with either an end ileostomy, or an ileal pouch anal anastomosis. Here we show that application of aggressive, multistage snare polypectomy to this situation can be effective and allow the patient to avoid surgery, at least in the short term. TECHNIQUE: Standard polypectomy using snare excision with coagulation is used, taking two or three sessions, and beginning with the largest polyps. The procedures are done with the patient under general anesthesia. Endoscopic mucosal resection technique with fluid injection to lift polyps is not necessary. RESULTS: Complete control of the rectal polyps, sustained for at least 2 years, is possible without functional sequelae. CONCLUSIONS: Familial adenomatous polyposis patients with severe rectal polyposis can be offered multistage rectal polypectomy and safely avoid proctectomy.IRB and consent approval through the David G Jagelman Inherited Colorectal Cancer Registry.
INTRODUCTION: When patients with familial adenomatous polyposis have a severely affected rectum it is usually assumed that endoscopic control is impossible or unwise. The standard approach is proctectomy with either an end ileostomy, or an ileal pouch anal anastomosis. Here we show that application of aggressive, multistage snare polypectomy to this situation can be effective and allow the patient to avoid surgery, at least in the short term. TECHNIQUE: Standard polypectomy using snare excision with coagulation is used, taking two or three sessions, and beginning with the largest polyps. The procedures are done with the patient under general anesthesia. Endoscopic mucosal resection technique with fluid injection to lift polyps is not necessary. RESULTS: Complete control of the rectal polyps, sustained for at least 2 years, is possible without functional sequelae. CONCLUSIONS:Familial adenomatous polyposispatients with severe rectal polyposis can be offered multistage rectal polypectomy and safely avoid proctectomy.IRB and consent approval through the David G Jagelman Inherited Colorectal Cancer Registry.
Authors: Gaia Colletti; Chiara Maura Ciniselli; Stefano Signoroni; Ivana Maria Francesca Cocco; Andrea Magarotto; Maria Teresa Ricci; Clorinda Brignola; Clara Bagatin; Laura Cattaneo; Andrea Mancini; Federica Cavalcoli; Massimo Milione; Paolo Verderio; Marco Vitellaro Journal: Cancers (Basel) Date: 2022-01-08 Impact factor: 6.639