Article Text


Endoscopy II
PTU-208 Laparoscopic assisted endoscopic mucosal resection (LAP-EMR)
  1. J Turner1,
  2. J Torkington2,
  3. M Davies2,
  4. S Dolwani1
  1. 1Gastroenterology, University Hospital Llandough, Cardiff, UK
  2. 2Colorectal Surgery, University Hospital Llandough, Cardiff, UK


Introduction Successful colonic endoscopic mucosal resection (EMR) may be limited by several factors such as lesion size, position, access and complexity. We present a series of cases performed by Lap-EMR, which has the potential to overcome these difficulties, safely extending the application of EMR.

Methods Cases were identified from a prospectively held database recording patient demographics, polyp details, procedural complications and follow-up outcomes.

Results 13 patients (62% male) underwent Lap-EMR between September 2008 and 2011. Median patient age 64 years old. Median polyp size 35 mm (range 12–60 mm). 85% of lesions were located within the right colon and 31% at either the hepatic or splenic flexures. Three patients required laparoscopic resection either due to lesion extension into the appendix (n=2) or failure to lift with submucosal injection (n=1), where histology revealed a focus of adenocarcinoma. One patient underwent a laparoscopic right hemicolectomy due to post-polypectomy haemorrhage. No other peri-operative complications occured. The median post-operative hospital stay was 2 days (range 1–19 days). Small residual adenoma was identified in 3 out of 6 patients that have undergone 3-month follow-up to date, successfully treated with argon photocoagulation. No adenoma was identifed in these patients at follow-up 1 year later.

Conclusion Lap-EMR is safe and effective in treating lesions that would otherwise require segmental colonic resection. It provides the option of localised laparoscopic resection, which is of particular benefit for lesions visible at the appendiceal orifice where suitability for resection can be difficult to assess at diagnostic colonoscopy.

Competing interests None declared.

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