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Surgical Endoscopy
Published in: Surgical Endoscopy 9/2014

01-09-2014

Endoscopic piecemeal resection of large colorectal polyps with long-term followup

Authors: Lillias H. Maguire, Paul C. Shellito

Published in: Surgical Endoscopy | Issue 9/2014

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Abstract

Background

Colonoscopic removal of large colorectal polyps is challenging and requires advanced endoscopic technique. Successful endoscopic management not only avoids the morbidity of surgery but also risks perforation, hemorrhage, and recurrence.

Methods

This study is a retrospective review of a prospectively maintained database of all patients undergoing cautery snare piecemeal polypectomy for large colorectal polyps by a single operator over 20 years with long-term followup.

Results

231 patients underwent 269 piecemeal polypectomies over a 20 year period. The complication rate was 4.3 %. Malignancy was identified in 25 (10.8 %) of patients. Local recurrences occurred in 24 % of patients with benign adenomas. The vast majority of these were managed with repeat endoscopy. Overall, benign large polyps were managed successfully endoscopically in 94.4 % of patients.

Conclusions

Piecemeal polypectomy is effective and safe for the management of large colorectal polyps. With long-term followup, the recurrence rate is appreciable, but most recurrences can be successfully managed with further endoscopic intervention. More complex techniques such as endoscopic submucosal dissection are usually unnecessary.
Literature
1.
2.
Winawer SJ, Zauber AG, O’Brien MJ et al (1993) Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. N Engl J Med 328:901–906PubMedCrossRef
3.
Patient Care Committee of the Society of Surgery of the Alimentary Tract (1999) Management of colonic polyps and adenomas. J Gastrointest Surg 3:220–222.
4.
Eisen GM, Chutkan R, Goldstein JL et al (2000) Guidelines for colorectal cancer screening and surveillance. Gastrointest Endosc 51:777–782CrossRef
5.
Bardan E, Bat L, Melzer E, Shemesh E, Bar-Meir S (1997) Colonoscopic resection of large colonic polyps—a prospective study. Isr J Med Sci 33(12):777–780PubMed
6.
Kao KT, Giap AQ, Abbas MA (2011) Endoscopic excision of large colorectal polyps as a viable alternative to surgical resection. Arch Surg 146(6):690PubMedCrossRef
7.
Dell’Abate P, Iosca A, Galimberti A, Piccolo P, Soliani P, Foggi E (2001) Endoscopic treatment of colorectal benign-appearing lesions 3 cm or larger: techniques and outcome. Dis Colon Rectum 44(1):112–118PubMedCrossRef
8.
Boix J, Lorenzo-Zúñiga V, Moreno de Vega V et al (2007) Endoscopic removal of large sessile colorectal adenomas: is it safe and effective? Dig Dis Sci 52(3):840–844PubMedCrossRef
9.
Binmoeller KF, Bohnacker S, Seifert H, Thonke F, Valdeyar H, Soehendra N (1996) Endoscopic snare excision of “giant” colorectal polyps. Gastrointest Endosc 43(3):183–188PubMedCrossRef
10.
Stergiou N, Riphaus A, Lange P, Menke D, Köckerling F, Wehrmann T (2003) Endoscopic snare resection of large colonic polyps: how far can we go? Int J Colorectal Dis 18(2):131–135PubMed
11.
Doniec JM, Löhnert MS, Schniewind B, Bokelmann F, Kremer B, Grimm H (2003) Endoscopic removal of large colorectal polyps: prevention of unnecessary surgery? Dis Colon Rectum 46(3):340–348PubMedCrossRef
12.
Walsh RM, Ackroyd FW, Shellito PC (1992) Endoscopic resection of large sessile colorectal polyps. Gastrointest Endosc 38(3):303–309PubMedCrossRef
13.
Buddingh KT, Herngreen T, Haringsma J et al (2011) Location in the right hemi-colon is an independent risk factor for delayed post-polypectomy hemorrhage: a multi-center case-control study. Am J Gastroenterol 106(6):1119–1124PubMedCrossRef
14.
Einspahr JG, Martinez ME, Jiang R et al (2006) Associations of Ki-ras proto-oncogene mutation and p53 gene overexpression in sporadic colorectal adenomas with demographic and clinicopathologic characteristics. Cancer Epidemiol Biomarkers Prev 15(8):1443–1450PubMedCentralPubMedCrossRef
15.
Seitz U, Bohnacker S, Seewald S, Thonke F, Soehendra N (2003) Long-term results of endoscopic removal of large colorectal adenomas. Endoscopy 35(8):S41–S44PubMedCrossRef
16.
Regula J, Wronska E, Polkowski M et al (2003) Argon plasma coagulation after piecemeal polypectomy of sessile colorectal adenomas: long-term followup study. Endoscopy 35(3):212–218PubMedCrossRef
17.
Moss A, Bourke MJ, Williams SJ et al (2011) Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 140:1909–1918PubMedCrossRef
18.
Byeon JS, Yang DH, Kim KJ et al (2011) Endoscopic submucosal dissection with or without snaring for colorectal neoplasms. Gastrointest Endosc 74:1075–1083PubMedCrossRef
19.
Saito Y, Uraoka T, Yamaguchi Y et al (2010) A prospective, multicenter study of 1111 colorectal endoscopic submucosa dissections (with video). Gastointest Endosc 72:1217–1225CrossRef
20.
Butte JM, Tang P, Gonen M et al (2012) Rate of residual disease after complete endoscopic resection of malignant colonic polyp. Dis Colon Rectum 55(2):122–127PubMedCrossRef
21.
Khashab M, Eid E, Rusche M, Rex DK (2009) Incidence and predictors of “late” recurrences after endoscopic piecemeal resection of large sessile adenomas. Gastrointest Endosc 70(2):344–349PubMedCrossRef
22.
Bedogni G, Bertoni G, Ricci E et al (1986) Colonoscopic excision of large and giant colorectal polyps. Technical implications and results over eight years. Dis Colon Rectum 29(12):831–835PubMedCrossRef
23.
Lee EJ, Lee JB, Lee SH et al (2012) Endoscopic treatment of large colorectal tumors: comparison of endoscopic mucosal resection, endoscopic mucosal resection-precutting, and endoscopic submucosal dissection. Surg Endosc 26:2220–2230PubMedCrossRef
24.
Tanaka S, Terasaki M, Hayashi N et al (2013) Warning for unprincipled colorectal endoscopic submucosal dissection: accurate diagnosis and reasonable treatment strategy. Dig Endosc 25:107–116PubMedCentralPubMedCrossRef
Metadata
Title
Endoscopic piecemeal resection of large colorectal polyps with long-term followup
Authors
Lillias H. Maguire
Paul C. Shellito
Publication date
01-09-2014
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 9/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3516-8

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