Introduction Modern endoscopic practice offers definitive management of colorectal polyps. However the role of this colon sparing minimally invasive modality is not clearly established in technically challenging “giant” polyps. Aim of this study was to evaluate the safety & short-term clinical outcomes of endoscopic resection of large colorectal polyps measuring 3 cm or more.
Methods All patients with colorectal polyps measuring ≥3 cm who underwent endoscopic or surgical treatment in our hospital from 2009 to 2016 were included in the study. Patient demographics & clinical data were collected from endoscopic and hospital database.
Results Over seven year period, 100 patients (median age: 72 years) were identified but complete data was available for 98 patients (25 right colon & 73 left colon). Median colorectal polyp size was 4.5 cm (range: 3–16 cm, & majority of polyps were in the rectum & sigmoid colon (69/98,69%) & predominantly sessile Paris type 1 s polyps. Four patients (4/98,4.1%) decided not to have treatment. Sixty-eight polyps (68/94,72.3%) were removed by endoscopic mucosal resection (EMR) or piece meal technique, of these fourteen patients (14/68,20.6%) needed more than one EMR session for the complete removal of the polyp. During follow-up, six patients (6/68,8.8%) who underwent previous EMR required additional surgical procedure in order to obtain complete polyp clearance. Following initial endoscopic assessment, surgical resection was deemed appropriate in twenty-six patients (26/94,26.5%) due to difficult location of the polyp & suspected/confirmed malignancy. Majority of the removed polyps were tubulovillous adenoma on histological confirmation. In the endoscopy group, twelve patients in endoscopy group (12/68,17.6%) had high-grade dysplasias (HGD) & four patients had invasive cancers (4/68,5.9%), of which two were considered cured & other two patients underwent further surgery. Among the surgical group seven (7/26,27%) & five (5/26,19%) patients had invasive cancer & HGD respectively. There were twelve procedure-related adverse events (12/68,17.6%) occurred in the endoscopy group, mainly occurred between 2008 & 2013 (eight minor bleeding requiring clips or additional cauterization). We have encountered only four complications between 2014 & 2016 (two minor & one major bleeding & one incidence of hypotension) despite performing more polypectomies. Outcome data for the surgical group was not available at present.
Conclusion Colorectal EMR for polyps of ≥3 cm can be performed at experienced endoscopy centres with a low rate of major complications. This modality offers a safe non-surgical option in management of large colorectal lesions especially in the elderly patients.
Disclosure of Interest None Declared
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