Article Text

PDF
PTH-041 Large (<4 cm) and giant (≥4 cm) colorectal polyps: comparison of piecemeal resection outcomes
  1. ZP Tsiamoulos,
  2. T Elliott,
  3. R Rameshshanker,
  4. N Suzuki,
  5. S Peake,
  6. L Bourikas,
  7. BP Saunders
  1. Wolfson Unit for Endoscopy, St Mark’s Hospital and Academic Institute, London, UK

Abstract

Introduction Piecemeal Endoscopic Mucosal Resection (p-EMR) is a standard and safe endoscopic technique for resection of large colorectal polyps (>2 cm). Limited data are available regarding p-EMR of giant polyps (>4 cm).

Method A prospective study recording short and long-term outcomes after p-EMR for colorectal polyps > 2 cm between Jan 2010 and August 2012 was conducted. We compared two cohorts of patients: group-A with large polyps (2 to <4 cm) vs group-B with giant (≥4 cm) polyps. Chi-square/Fischer’s tests were performed between categorical variables including patient demographics/polyp features/techniques applied {p-EMR with spiral snare and hybrid p-EMR). Our primary outcome was to compare the safety, efficacy and complication rate between the two groups.

Results Group-B patients were older than group-A patients (mean 70.6 vs. 67.8 yrs, p = 0.01) and were more likely to have come from a tertiary referral source (p = 0.05). Large polyp referrals were almost twice as frequent as giant polyp referrals (218 vs. 123, p < 0.001). Median polyp size was 2.5cm in group-A and 5cm in group-B. Giant polyps were most commonly found in the recto-sigmoid segment (26% rectum and 28% sigmoid, p < 0.001), whilst large polyps were more evenly distributed throughout the colon. No significant difference in cancer prevalence was recorded between the groups.

Endoscopic excision was complete in 89% in large (median time 18min) and in 70% in giant groups (median time 38min). All large polyps were excised in one session, whilst 4% of giant polyps required more than one session. Incomplete submucosal lift (46% vs 63%, p = 0.002) and difficult polyp position (45% vs 63%, p < 0.001) were more common in giant polyps. Spiral snare EMR (6% vs 28%, p < 0.001) and hybrid (0% vs 7%, p < 0.001) techniques were more commonly used in giant than in large polyps. Procedural bleeding occurred more frequently in giant polyps (5% vs 17%, p < 0.001). Delayed bleeding was also significantly higher in giant polyps (15% vs 34%, p < 0.001), but hospitalisation or further intervention did not vary significantly by polyp size. The overall long-term recurrence at 24 months was 17% (11% vs 28%, p = 0.02). The follow up occurrence was more frequent for giant polyps at 3 month (43% vs 72%, p < 0.001) and 9 month (14% vs 26%, p = 0.007) intervals. Benign recurrence requiring surgery and the cancer prevalence did not vary between polyp size group.

Conclusion Piecemeal resection is a safe and efficacious modality for the resection of colorectal polyps >4 cm. However, these giant polyps more often require spiral snare or hybrid resection techniques and their higher adenoma recurrence rate post p-EMR may dictate shorter surveillance intervals.

Disclosure of interest None Declared.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.