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.

Large endoscopic mucosal resection for colorectal tumors exceeding 4 cm

AIM:To evaluate the feasibility and the outcome of endoscopic mucosal resection(EMR)for large colorectal tumors exceeding 4 cm(LCRT)undergoing piecemeal resection. METHODS:From January 2005 to April 2008,146 digestive tumors larger than 2 cm were removed with the EMR technique in our department.Of these,34 tumors were larger than 4 cm and piecemeal resection was carried out on 26 colorectal tumors.The mean age of the patients was 71 years.The mean follow-up duration was 12 mo. RESULTS:LCRTs were located in the rectum,left colon,transverse colon and right colon in 58%,15%, 4%and 23%of cases,respectively.All were sessile tumors larger than 4 cm with a mean size of 4.9 cm (4-10 cm).According to the Paris classification,34%of the tumors were typeⅠs,58%typeⅡa,4%typeⅡb and 4%typeⅡc.Pathological examination showed tubulous adenoma in 31%,tubulo-villous adenoma in 27%,villous adenoma in 42%,high-grade dysplasia in38%,in situ carcinoma in 19%of the cases and mucosal carcinoma(m2)in 8%of the cases.The two cases(7.7%)of procedural bleeding that occurred were managed endoscopically and one small perforation was treated with clips.During follow-up,recurrence of the tumor occurred in three patients(12%),three of whom received endoscopic treatment. CONCLUSION:EMR for tumors larger than 4 cm is a safe and effective procedure that could compete with endoscopic submucosal dissection,despite providing incomplete histological assessment.

Efficacy, risk factors and complications of endoscopic polypectomy: Ten year experience at a single center

AIM: To examine the efficacy and complications of colonoscopic resection of colorectal polypoid lesions. METHODS: We retrospectively reviewed 1354 polypectomies performed on 1038 patients over a ten- year period. One hundred and sixty of these were performed for large polyps, those measuring ≥ 20 mm. Size, shape, location, histology, the technique of polypectomy used, complications, drugs assumption and associated intestinal or extra intestinal diseases were analyzed. For statistical analysis, the Pearson χ2 test, NPC test and a Binary Logistic Regression were used. RESULTS: The mean patient age was 65.9 ± 12.4 years, with 671 men and 367 women. The mean size of polyps removed was 9.45 ± 9.56 mm while the size of large polyps was 31.5 ± 10.8 mm. There were 388 pedunculated and 966 sessile polyps and the most common location was the sigmoid colon (41.3%). The most frequent histology was tubular adenoma (55.9%) while for the large polyps was villous (92/160 -57.5%). Coexistent malignancy was observed in 28 polyps (2.1%) and of these, 20 were large polyps. There were 17 procedural bleeding (1.3%) and one perforation. The statistical analysis showed that cancer is correlated to polyp size (P < 0.0001); sessile shape (P < 0.0001) and bleeding are correlated to cardiac disease (P = 0.034), tubular adenoma (P = 0.016) and polyp size.CONCLUSION: The endoscopic resection is a simple and safe procedure for removing colon rectal neoplastic lesions and should be considered the treatment of choice for large colorectal polyps. The polyp size is an important risk factor for malignancy and for bleeding.

Unlocking quality in endoscopic mucosal resection

A review of the development of the key performance metrics of endoscopic mucosal resection(EMR),learning from the experience of the establishment of widespread colonoscopy quality measurements.Potential future performance markers for both colonoscopy and EMR are also evaluated to ensure continued high quality performance is maintained with a focus service framework and predictors of patient outcome.