Introduction Large rectal polyps can cause a variety of symptoms. Removal of these lesions results in symptom resolution but may also lead to symptoms of evacuatory dysfunction. In this study, we present the functional outcomes and patient satisfaction after endoscopic submucosal dissection (ESD) of rectal polyps greater than 40mm in size.
Methods This was a retrospective analysis of patients who underwent ESD or hybrid ESD/endoscopic piecemeal resection (ESD/EPMR) of large benign rectal polyps. Details pertaining to the polypectomy were gathered and patients were asked a series of questions regarding their bowel function before and after endoscopic resection.
Results Thirty four patients underwent ESD or hybrid ESD/EPMR for large rectal polyps between January 2006 to May 2012. The median maximal polyp measurement was 62mm (range 40 – 150mm) and median circumferential involvement, 50% (range 30 – 90%). The patients had symptoms of the passage of mucous (12 patients), rectal bleeding (9)and faecal incontinence (1) before the treatment. In all cases, these symptoms resolved after the treatment. Regarding the bowel function post procedure, 16 patients (47.1%) opened their bowel less frequently, 12 patients (35.3%) the same and 6 patients (17.6%) more frequently. Eighteen patients felt that their completeness of evacuation was the same, 8 improved and 5 worsen. Almost all of the patients (33 patients, 97.1%) did not use laxatives before their polypectomy, however 14 patients (41.2%) required the regular use of laxatives post procedure. None of the cases did not require any further intervention like dilatation. There was no relationship between circumferential involvement and patients who developed a decreased frequency of defecation or who used laxatives after ESD (Mann-Whitney Test, p = 0.567). On a scale of 1 to 10, where 1 was extremely unsatisfied and 10 was extremely satisfied, the patients rated their ESD experience at 10 (Median, Range 7 – 10).
Conclusion ESD of large rectal polyps resulted in an improvement in symptoms of rectal bleeding and passage of mucous. It also results in a decreased frequency of defecation and an increase in use of laxatives. Functional outcomes are not related to polyp size or circumferential involvement. Patients were extremely satisfied with their ESD experience.
Disclosure of Interest None Declared.
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