Introduction Endoscopic mucosal resection (EMR) is an effective therapeutic technique for removal of large colorectal sessile polyps, and provides an alternative to surgery. To minimise the risks of serious complications only experienced and appropriately trained endoscopists should perform EMR.
We aimed to evaluate the outcomes, major complications and recurrence rate for large (20 mm–39 mm) and giant (≥ 40 mm) sessile colorectal polyps.
Method All EMRs for large ((≥ 20mm) sessile polyps performed between January 2010 and May 2014 were evaluated. The post-EMR major complications, recurrence rate and the technique (en bloc versus piecemeal resection) were analysed.
This retrospective study was performed during two separate time periods. The initial study was performed for the polyps managed from January 2010 to December 2012. Post-analysis, specific recommendations were made, particularly to restrict the EMR to the experienced and appropriately trained endoscopists. The subsequent study was performed on the data collected between January 2013 and May 2014, and the comparison of the two studies confirmed better outcomes of the management of the polyps due to the recommendations made in the initial study.
Results A total of 121 polyps were resected in 117 patients. There were 76 (64.95%) males and 41 females. Mean (± SD) age of the patients was 71.15 (± 10.13) years. There were 92 large polyps (76%) with a mean size of 26.93 (± 4.80) mm (range 20 – 39 mm), and 29 giant polyps (24%) with a mean size of 50.68 (± 12.79) mm (range 40 – 90 mm). The most frequent location was the sigmoid colon (24.79%). 42.14% of the total polyps were on the right side of colon. Enbloc resection was performed in 35 (29.91%) and piecemeal in 82 (70.08%).
No immediate or delayed major bleeding occurred. One patient had bowel perforation. Two patients had intramucosal cancer, two had adenocarcinoma, and one patient had a rare finding of MALT lymphoma. Recurrence occurred in 6 polyps.
Conclusion In our experience EMR- related major complications are low and comply with international standards. The technique requires an individualised approach by the experienced endoscopist, taking into consideration a thorough assessment of a particular patient and their polyp.
Disclosure of interest None Declared.
British Society of Gastroenterology Guidelines
American Society of Gastroenterology Guidelines