EMR of large sessile colorectal polyps

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Abstract

Background

EMR optimizes histopathologic assessment of resected lesions. This study evaluated the outcome of EMR of large sessile colorectal polyps in terms of complications and recurrence.

Methods

An uncontrolled prospective study was conducted of a cohort of 136 patients with sessile colorectal polyps referred for EMR. After submucosal injection, EMR was performed piecemeal by either snare polypectomy alone or with cap aspiration.

Results

In 136 patients, a total of 139 sessile polyps were resected, 86 of which were in the right colon. Median polyps diameter was 20 mm in the right colon and 30 mm in the other colonic segments. Intraprocedure bleeding occurred after 15 polypectomies (10.8%) and was controlled endoscopically in all cases; there was no delayed bleeding. Post-polypectomy syndrome occurred in 5 patients (3.7%). There was no perforation. Invasive carcinoma was found in 17 sessile colorectal polyps, and surgery was performed in 10 of 17 cases. Follow-up colonoscopy in 93 patients without invasive carcinoma (96 polyps), over a median of 12.3 months, disclosed local recurrence of 21 adenomatous polyps (21.9%). Colonoscopic follow-up in 5 of the 7 patients, who had sessile colorectal polyps with invasive carcinoma and did not undergo surgery, disclosed no local recurrence.

Conclusions

EMR, including EMR with cap aspiration, is effective and safe for removal of sessile colorectal polyps throughout the colon.

Section snippets

Patients

An uncontrolled prospective study was conducted of a cohort of patients with known large sessile colorectal polyps who were referred for EMR. Patients were treated in 3 departments of gastroenterology (regional referral centers). All patients were identified by colonoscopy performed in these centers or by colleagues in other hospitals. The study protocol was approved by the institutional review board of our National Institute for Cancer Research. All patients were invited to participate, and

Results

A total of 139 SP were treated by piecemeal EMR in the 136 enrolled patients. Three patients had more than one polyp. The characteristics of the study group and the size and the location of the SP are given in Table 1; 61.9% were in the cecum or ascending colon (RC). The median diameter of SP in the RC was 20 mm and 30 mm (20-100 mm) for those located distal to the RC. A positive correlation was observed between polyp size and patient age (Spearman test, p < 0.0001). The characteristics of the

Discussion

A total of 139 SP, 86 in the RC, were removed in the present study by using one of two EMR techniques with minimal complications. The study was not a randomized comparison of the two techniques. The choice of technique was determined by the morphology of the lesion and its location. Some lesions could only be treated by one of the two methods. The use of piecemeal technique was unavoidable in all instances, because of the large diameter of the lesions and/or the location. Large polyps have been

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