Introduction Large (>2 cm) rectal adenomas are currently treated by trans-anal endoscopic microsurgery (TEMS) or endoscopic mucosal resection (EMR). The aim of this study is to report on the effectiveness, safety and final outcome of both procedures in patients at a single tertiary health centre in the UK.
Methods A cross-sectional study comparing patients and polyps specific variables in patients that underwent transanal endoscopic resection (TEMS) or endoscopic mucosal resection (EMR) for large rectal polyps, during 2011 to 2015. The data was obtained from colorectal multidisciplinary team (MDT) records, supplemented by information from the endoscopy reporting tool of the Hospital (Unisoft®). Variables analysed included polyp size, patient’s age and gender, procedure complication rate, success and failure rate. We also looked for the number for emergency admission needed. Chi-squared test was used to compare rates of examined variables between both techniques.
Results Fifty four patients (mean age 74 ± 10.8) underwent EMR whilst fifty three patients (mean age 68 ± 11) had TEMS. Male: female ratio was 1:2 respectively (p value =0.16). Mean polyp sizes were 3 cm (range 2–10 cm) and 3.5 cm (range 2–10 cm) for EMR and TEMS, respectively (p value 0.4). The success rates of both procedures were comparable (92.6% and 88.7% for EMR and TEMS respectively). On the contrary, complication rate was slightly higher in those that had TEMS: 5.7% (1.9% post EMR, p value 0.29). We observed in our study that 9.4% of those who had TEMS required second, high risk surgery (3.7% had Anterior resection, 3.7% required Extralevator abdominoperineal excision ELAPE and 1.8% had Hartman’s surgery). 37% of patients underwent EMR polypectomy required second procedure (further EMR or TEMS) for complete excision. There was a significantly higher recurrence rate post EMR than post TEMS (34% and 7.4% respectively, p0.001)
Conclusion In this single tertiary centre, both EMR and TEMS offered similar effectiveness in the treatment of large rectal polyps. The higher recurrence rate of polyps post EMR relative to TEMS engenders further investigation.
Disclosure of Interest None Declared
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