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Original article
Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis
  1. C Hassan1,
  2. A Repici2,
  3. P Sharma3,
  4. L Correale4,
  5. A Zullo1,
  6. M Bretthauer5,6,
  7. C Senore7,
  8. C Spada8,
  9. Cristina Bellisario9,
  10. P Bhandari10,
  11. D K Rex10
  1. 1Endoscopy Unit, ‘Nuovo Regina Margherita Hospital’, Rome, Italy
  2. 2Digestive Endoscopy Unit, Istituto Clinico Humanitas, Milan, Italy
  3. 3Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Kansas, USA
  4. 4im3D S.p.A., Turin, Italy
  5. 5Department of Health Economy and Health Management, University of Oslo, Oslo, Norway
  6. 6Gastroenterology Unit, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
  7. 7AOU S Giovanni Battista-CPO Piemonte, SCDO Epidemiologia dei Tumori 2, Turin, Italy
  8. 8Digestive Endoscopy Unit, Catholic University, Rome, Italy
  9. 9Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
  10. 10Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA
  1. Correspondence to Dr Cesare Hassan, Nuovo Regina Margherita, Via Morosini 30, Roma 00153, Italia; cesareh{at}


Objective To assess the efficacy and safety of endoscopic resection of large colorectal polyps.

Design Relevant publications were identified in MEDLINE/EMBASE/Cochrane Central Register for the period 1966–2014. Studies in which ≥20 mm colorectal neoplastic lesions were treated with endoscopic resection were included. Rates of postendoscopic resection surgery due to non-curative resection or adverse events, as well as the rates of complete endoscopic removal, invasive cancer, adverse events, recurrence and mortality, were extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random effect models. I2 statistic was used to describe the variation across studies due to heterogeneity. Meta-regression analysis was also performed.

Results 50 studies including 6442 patients and 6779 large polyps were included in the analyses. Overall, 503 out of 6442 patients (pooled rate: 8%, 95% CI 7% to 10%, I2=78.6%) underwent surgery due to non-curative endoscopic resection, and 31/6442 (pooled rate: 1%, 95% CI 0.7% to 1.4%, I2=0%) to adverse events. Invasive cancer at histology, non-curative endoscopic resection, synchronous lesions and recurrence accounted for 58%, 28%, 2.2% and 5.9% of all the surgeries, respectively. Endoscopic perforation occurred in 96/6595 (1.5%, 95% CI 1.2% to 1.7%) polyps, while bleeding in 423/6474 (6.5%, 95% CI 5.9% to 7.1%). Overall, 5334 patients entered in surveillance, 502/5836 (8.6%, 95% CI 7.9% to 9.3%) being lost at follow-up. Endoscopic recurrence was detected in 735/5334 patients (13.8%, 95% CI 12.9% to 14.7%), being an invasive cancer in 14/5334 (0.3%, 95% CI 0.1% to 0.4%). Endoscopic treatment was successful in 664/735 cases (90.3%, 95% CI 88.2% to 92.5%). Mortality related with management of large polyps was reported in 5/6278 cases (0.08%, 95% CI 0.01% to 0.15%).

Conclusions Endoscopic resection of large polyps appeared to be an extremely effective and safe intervention. However, an adequate endoscopic surveillance is necessary for its long-term efficacy.


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