Introduction Patients with large sessile colorectal polyps can be technically challenging to resect endoscopically and have been subject to colorectal resection in the United Kingdom and in several centres in the Western world. Surgery can be associated with significant morbidity and mortality particularly in the elderly and in patients with rectal lesions.
Our aims were to determine the safety and efficacy of endoscopic resection of large colorectal lesions at a tertiary referral unit.
Method All patients with colorectal polyps greater than or equal to 8 cm deemed suitable for endoscopic resection were included in the study. Patients underwent magnification colonoscopy after dye spraying with 0.4% indigo carmine under midazolam sedation after oral bowel preparation. Snares were utilised for endoscopic mucosal piecemeal resection (EMR) and the Fuji flush knife for endoscopic submucosal dissection (ESD). The scar was examined with magnification chromoendoscopy post resection to check for residual disease. All patients underwent follow up magnification colonoscopy at 3 and 12 months by the same endoscopist.
Results 84 endoscopic resections of lesions greater than or equal to 8 cm were undertaken, with a mean age of 72 years (SD 10.6). The location of lesions included rectum (n = 23); recto-sigmoid (n = 25); sigmoid (n = 26); descending colon (n = 2); ascending colon (n = 4) and caecum (n = 4). The mean size of the polyps was 102 mm. Histology revealed 78 tubulo-villous adenoma, 5 tubular adenomas and 1 adenocarcinomas. All lesions were resected completely with curative intent.
There were 3 perforations (3.6%) all of which were closed endoscopically using clips without need for further surgery. One of the patients had evidence of post procedure haemorrhage. The local recurrence rate was 9.5%. The rate of complications and recurrence were significantly higher than that seen in patients with lesions less than 8 cm (n = 180).
Conclusion Endoscopic resection of giant colorectal adenomas may be undertaken with low risk of complications thereby avoiding the need for surgical resection. Nonetheless, it is associated with a higher risk of complications, recurrence and admission to hospital when compared with lesions less than 8 cm and therfore should be considered in specialist units.
Disclosure of interest None Declared.
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