Introduction Large sessile colonic polyps are increasingly managed by endoscopic mucosal resection (EMR); a large multicentre Australian study of 479 patients showed that 89% of sessile polyps were removed in a single session, 20% recurred of which 90% were successfully retreated.
Methods To assess success of EMR of colonic sessile polyps (2 operators, 1 centre), recurrence, complications and need for surgery.
68 patients Mean patient age 68.5 years; 70 sessile polyps (2 patients had 2 large polyps each); mean size 35 mm (range: 20–100 mm), underwent EMR 2009–2013.
Follow up: mean 11 months (range: 3–38 m).
Indications: 25% of patients from BCSP.
Site: rectum (46%), sigmoid (27%), descending (3%), transverse (7%), ascending (7%) and caecum (10%).
Results 4/70 polyps contained foci of adenocarcinoma. 1/4 with cancer had surgery and 11/70 await check endoscopy; thus, 47/59 (80%) had no recurrence at repeat endoscopy (including 3/4 with foci of cancer). Of 12/59 (20%) recurrences, 8 were retreated (2 required more than 1 re-treatment) and remain polyp free. 1 further recurrence is still under endoscopic FU.
Surgery: The remaining 3 recurrences had surgery (2 rectal, 1 caecal); the surgical specimen from 1 rectal recurrence contained unsuspected cancer. The one patient who had surgery for a polyp-cancer showed no residual tumour in the operative specimen.
Complications: There were no deaths nor surgery required for complications. 13 (19%) procedural bleeding successfully treated (diathermy/clips); 1 perforated rectal EMR clipped and 1 post-polypectomy pain syndrome, both resolved with conservative management.
Conclusion Large sessile colonic polyps can be managed safely and effectively with EMR. We achieved 93% complete eradication of the polyps (8 after retreatment).
Reference Moss A, Bourke MJ, Williams SJ, et al. Gastroenterology 2011 140(7):1909–18
Disclosure of Interest None Declared.
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