Recurrence after endoscopic piecemeal mucosal resection for large sessile colorectal polyps

AIM: To evaluate the safety and outcomes of endoscopic piecemeal mucosal resection (EPMR) for large sessile colorectal polyps. METHODS: The patients enrolled in this study were 47 patients with 50 large sessile polyps (diameter, 2 cm or greater) who underwent EPMR using a submucosal saline injection technique between December 2002 and October 2005. All medical records, including characteristics of the patients and polyps, complications, and recurrences, were retrospectively reviewed. The first follow-up endoscopic examination was performed at 3-6 mo after initial endoscopic resection, and the second at 12 mo postEPMR. Subsequent surveillance colonoscopic examinations were individualized, taking risk factors into account. RESULTS: The patients were 23 men and 24 women,with a mean age of 60 years. Mean polyp size was 30.1 mm. Of 50 polyps identified, 34 (68%) were benign and 16 (32%) were malignant. There were 6 (12%) cases with EPMR-related bleeding: 5 intra-procedural and 1 early post-procedural bleeding. All bleeding episodes were managed by endoscopic clipping or argon beam coagulation. There were no perforations. Recurrence was identified in 5 cases (12.2%): 4 local recurrences detected at 3 mo post-EPMR and 1 local recurrence detected at 14 mo post-EPMR. The recurrence rate after EPMR was 3.1% for benign polyps and 33.3% for malignant polyps (P < 0.05). Median follow-up time was 37 mo. CONCLUSION: EPMR is safe, but should be applied carefully in malignant polyps. Close follow-up endoscopic examinations are necessary for early detection of recurrence.

Delayed perforation after endoscopic resection of a colonic laterally spreading tumor:A case report and literature review

BACKGROUND Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)have been widely used for the treatment of early gastrointestinal cancer.Endoscopic piecemeal mucosal resection(EPMR)is derived from the combination of EMR and ESD.Delayed perforation with peritonitis after colonic EPMR is a rare but severe complication,sometimes requiring surgery.There are some associated risk factors,including patient-(location,diameter,and presence of fibrosis)and procedure-related factors.Early recognition and timely treatment are crucial for its management.CASE SUMMARY We report a case in which delayed perforation with peritonitis was treated using endoscopic closure.A 54-year-old man was diagnosed with a 30-mm-diameter laterally spreading tumor in the colonic hepatic curvature.Fifteen hours after endoscopic resection,peritonitis caused by delayed perforation occurred and gradually aggravated.Conservative treatment was ineffective and no obvious perforation was observed.After timely endoscopic closure,the patient was discharged on postoperative day 4.CONCLUSION In occasion of localized peritonitis aggravating without macroscopic perforation,endoscopic closure is an effective treatment for delayed perforation with stable vital signs in the early stage.