Introduction Bowel cancer is the third most common cancer in the United Kingdom forming up to 13.6% of all newl1y diagnosed cancers (1). Bowel cancer screening colonoscopy allows early polyp detection at a curable stage. Complete resection and follow-up of large polyps is crucial to prevent malignant progression.
The aim of this study was to review the management of polyps with diameters ≥2 cm, particularly of sessile polyps, to assess the enbloc resection rates, completeness of resection using endoscopic mucosal resection (EMR) vs surgery and the incidence of malignant polyps.
Methods Patients were identified retrospectively from a regional bowel screening programme database. Details of index colonoscopy including polyp characteristics, method of resection and complications were recorded. Histology results were reviewed for all polyps. Outcomes from follow-up endoscopic surveillance were analysed.
Results One hundred and fifty-eight patients (102 males, 56 females, mean age 66.2 years) with polyps ≥2 cm were identified from 2182 screening colonoscopies from January 2010 to August 2013. Caecal intubation rate was 96.8% in this group.
Largest polyp size for each patient ranged from 20 to 60 mm (mean 26.6 mm). The incidence of adenocarcinoma was 11.9% (n = 19), all located within the left colon, with 12 requiring surgical resection.
One hundred thirty nine patients (n = 139) had 155 non-malignant large polyps, mostly tubulovillous or villous histology (n = 110, 79%).
Thirty-six patients had 37 sessile polyps which underwent primary resection by EMR (n = 26) or surgery (n = 11).
Polyp diameter was larger in the surgery group with mean polyp diameter of 40.4 vs. 28.0 mm (p < 0.05).
EMR enbloc resection rate was 11.5% (n = 3 out of 26). Completeness of excision was 38.4% (n = 10) at 3 months and 92.3% (n = 24) at 1 year. EMR complications included 1 perforation, 1 post polypectomy syndrome and 1 bleed.
Surgical resection included: anterior resection in 2, TEMS excision in 7 and right hemicolectomy in 3.
Conclusion Sessile polyps ≥2 cm are relatively uncommon in an asymptomatic bowel cancer screening programme (37 in 2182 colonoscopies). They can be successfully resected by EMR without recurrence in 92.3% at 1 year providing a 3 month site check is performed in all piecemeal polypectomies.
Cancer for National Statistics 2010. Office for National Statistics. http://www.ons.gov.uk/ons/dcp171778_263537.pdf
Disclosure of Interest None Declared.
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