Introduction Advanced endoscopic mucosal resection (EMR) techniques are promoting the resection of large polyps and early cancers. However there remain concerns with safety and risk of cancer as the polyp size increases. In our practice we are removing large lesions and decided to analyse those >40 mm in size with respect to outcome and cancer prevalence.
Methods A retrospective analysis of endoscopy and pathology records was undertaken to collect our experience over the last 5 years, with interview of the endoscopists. All lesions were removed by a single experienced endoscopist using modern EMR techniques.
Results In our analysis there are 65 patients, 29 females, with a mean age 71 years. There are 65 polyps with mean size of 57 mm (40–150 mm), and mean follow-up is 18 months (1-57). In our series 68% of all patients had complete eradication of neoplasia, 11% are pending first follow-up, 12% have residual disease, and 7% have had surgery. 4/65 (6%) patients had delayed bleeding managed endoscopically, there were no perforation. There is no statisitically significant difference in the incidence of carcinoma or complications when comparing polyps between 40-59 mm in size with polyps >79 mm in size (p=0.339, p=0.537). There is no significant different in giant polyps from our data on polyps 20–40 mm in size (p=1.00, p=0.416, Fishers exact test). 3/8 patients with cancer had <SM-1 disease and have been followed up endoscopicaly with good outcome. 5/8 patients had uncertain invasion or >SM-1 disease, 4/5 were fit for surgery and have had surgery with good a outcome and 1/5 had further endotherapy due to high surgical risk. Analysing polyps by site, 90% are in the rectum and left colon, and 82% of these are LGD lesions, 6% HGD, and 12% carcinoma.
Conclusion Endoscopic resection of polyps >40 mm is feasible, and safe. The risks of complications are significant, but low, and are independent of size in this series of polyps >40 mm. Cancer prevalence is 12% but is independent of size. Endoscopic resection was curative in the majority of benign polyps and provides accurate staging information in cancers leading to uncomplicated standard surgical resection.
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