Introduction Colonic polyps sized 50 mm and above are traditionally treated by surgical resection. Endoscopic resection has now become increasingly common as the expertise of western endoscopists improves. There is very little published literature on endoscopic resection of these giant polyps.
We aim to evaluate the feasibility, safety and efficacy of endoscopic resection of giant polyps ≥50 mm in size.
Methods Prospective cohort study. All patients who underwent endoscopic resection of colonic polyps ≥50 mm from 2007–2013 were prospectively entered into a database. We excluded all polyps with fibrosis related to previous intervention. All patients were tertiary referrals from experienced gastroenterologists. All procedures were performed by a single experienced endoscopist.
Results N = 124 polyps in 122 patients. Mean polyp size = 71 mm. Range 50–170 mm. 27(22%) in right colon and 97 (78%) in left colon. M:F ratio 1.1:1. All polyps were resected in a piecemeal fashion. The mean procedure time was 120 min (range 90 to 240).
The complication rate was 11/124(8.9%). All these patients required inpatient stay. There were 9 bleeds (3 immediate and 6 delayed), 1 post polypectomy syndrome and 1 case of split muscle fibres (clipped endoscopically). 1 case of immediate bleeding required surgery to control the bleeding. All the others were managed conservatively. 4 of the 9 bleeds required blood transfusion. The complication rate was independent of polyp size, resection technique or site of the lesion.
Follow up data was available for 90 polyps. The recurrence rate was 21/90 (23.3%). Of the 21 recurrences, 16/21(76%) patients achieved complete clearance with a further 1 to 2 endoscopic procedures. The recurrence rate was significantly dependent on polyp size and was not dependent on the resection technique or the site of the lesion. Recurrence gradually increased with an increase in polyp size up to 70 mm. Recurrence was seen in 3/34(8.8%) polyps ≤55 mm, in 7/54 (12.9%) polyps ≤60 , Shemm and in 9/63 (14.2%) polyps ≤70 mm. However, in polyps >70 mm, the recurrence rate greatly increased to 12/27 (44%) (p = 0.002).
It is safe and feasible to endoscopically resect polyps 50–170 mm in size.
Recurrence is significantly dependent on polyp size.
Giant polyps resected endoscopically have a significant recurrence rate. The majority of these can be cleared by further endoscopic procedures. However, we believe that the recurrence rate in polyps above 70 mm is very high and surgery should be considered in these cases.
Complication rates are independent of size.
Disclosure of Interest None Declared.