Introduction Colonoscopic removal of large colorectal polyps, sessile or pedunculated, can pose a challenge. Techniques most commonly used are hot snare polypectomy or endoscopic mucosal resection using electrocautery snare. The bigger the size of the polyp greater the skill needed to avoid complications. The potential complications are bleeding and perforation. According to the British Society of Gastroenterology guidelines post polypectomy bleeding requiring transfusion should be <1:100 (for >1 cm polyps) and post polypectomy perforation rate should be <1:500.
Methods A retrospective audit was taken between the dates of October 2009 to October 2010 and included patients who had large polyps, defined as polyps equal to and >20 mm in size, removed from the colorectal region by various colonoscopists during their routine colonoscopy lists in a district general hospital. The size of the polyp was confirmed from both the colonoscopy and histology report.
Results In total 64 patients with large colorectal polyps were treated. Majorities were pedunculated (n=49) and the rest were sessile (n=15). In the group of patients who had pedunculated polyp, 29 were male and 20 were female with a mean age of 62.72 years. The average size of the polyp was 26.22 mm (range: 20–50). Snare polypectomy was performed for all pedunculated polyps. The colonoscopists were able to remove the polyp enbloc in 87.7% of patient (n=43) while in the rest polyps were removed piecemeal (n=6). There was no reported perforation or major bleeding requiring blood transfusion. Only 4 (8.1%) patients had minor bleeding which was successfully controlled during the procedure and no further intervention was required. Histologically, pedunculated polyps were 93.9 % villous or tubulvillous (n=46), 4.1% hamartomatous (n=2) and 2% benign leimyoma (n=1). In the group of patient who had sessile polyp, 10 were male while rest were female. There mean age was 71.93 years. The average size of the polyp was 33.67 mm (range: 20–55). Endoscopic mucosal resection was performed in all of them. The polyp was removed enbloc in only three cases (20%) while in rest it was removed piecemeal (n=12). There was no reported perforation or blood loss requiring blood transfusion. Only 1 (6.66%) of the patient had a minor bleeding which was controlled during the procedure. All 15 of sessile polyp were histological either villous or tubulovillous.
Conclusion The complication rates of colonoscopic removal of large pedunculated and sessile polyps in a district general hospital are very low as evident from the data presented. Hence these procedures when performed by skilled colonoscopists are safe and can save the patient from major surgical procedures.
Competing interests None declared.
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