Introduction Endoscopic mucosal resection (EMR) of colorectal polyps has been reported to be a safe and effective technique within the UK. Most series have however included smaller polyps (1 cms or less) and there is paucity of data on EMRs limited to large polyps. We report the outcomes on a series with large polyps (>2 cms) from a bowel cancer screening centre in the UK.
Methods A total of 5190 polypectomies were performed within the region from January 2008 to December 2011 on the Bowel Screening Programme. Data were collected from three hospitals on all large polyp EMR greater than 2 cm in size. Data were analysed using the SPSS V.20.
Results A total of 61 patients with polyps 2cm or greater were identified. The mean age was 69 years, 75% (n=46) of which were male. The mean size of the polyps resected was 35 mm (range 20–60 mm). The majority of the polyps were sessile (n=40) and located in the left colon (n=43). Tattooing was performed in 46% (n=28) and Argon-beam photocoagulation (APC) therapy was applied in 41% of cases (n=25). In 97%, the resections were complete (n=59). Histopathology results were obtainable in 57 patients of whom 12% (n=7/57) showed high grade dysplasia and 5% (n=3/57) were confirmed as adenocarcinoma. The overall major complication rate was 3% (n=2). Both complications were bleeding post-EMR. Surveillance data were available for 43 patients up-to 12 months post EMR. Six recurrences (10%) were seen at the EMR site at 3 months, five of these in left colon. On reviewing their initial EMR, the polyps had a median size of 25±6 mm; 50% (n=3/6) had APC therapy and 5/6 the excision was endoscopically complete on initial EMR. Histology confirmed low grade dysplasia (LGD) in all cases. Recurrence was endoscopically treated successfully in all cases. Recurrence rate was not influenced by the size or site of the polyp or APC therapy. Sessile polyp EMR were more likely to show recurrence (n=5/6). At 12 months, eight patients had recurrence. Six of these patients had endoscopically complete excision on initial EMR. On reviewing their initial EMR, the polyps had a median size of 35±5 mm; 50% had APC therapy. Recurrence was treated successfully in all cases.
Conclusion Endoscopic mucosal resection for large colorectal polyps is safe with relatively low complication rates compared to laproscopic surgery. Recurrence rate is low at 3 months but can still occur upto 12 months in lesions felt to be completely excised.
Competing interests None declared.
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