Long-Term Results of Endoscopic Removal of Large Colorectal Adenomas

Background and Study Aims: Endoscopic removal of large colorectal polyps has not been widely accepted. The aims of this study were to evaluate our longterm experiences justifying endoscopic resection technique as the treatment of choice.
Patients and Methods: During a period of 12 years, 288 patients with a total of 302 polyps larger than 3 cm in diameter were treated endoscopically. 224 polyps were sessile and 78 pedunculated. Sessile polyps were removed using the piecemeal technique. Surgery was recommended in patients with unfavorable histology. Patients with favorable histology were followed up at 3 – 6 month intervals in the first year and then every 1 – 2 years.
Results: A total of 184 patients with sessile polyps were followed up for at least 6 months. Recurrence rate of 166 benign polyps was 17 % (29/166). Only two patients had malignant recurrence. 8 of 18 patients with malignant polyps underwent surgery while 10 were unfit for surgery. 8 of these patients remained free of recurrence.
Conclusions: Previous concerns about endoscopic removal of large colorectal polyps are no longer justified. The results of this study showed that endoscopic resection of large colorectal polyps is safe and effective. In patients with high operative risk, endoscopic removal may be adequate.

References

• 1 Christie J P. Colonoscopic excision of large sessile polyps.  Am J Gastroenterol. 1977;  67 430-438
• 2 Bedogni G, Bertoni G, Ricci E. et al . Colonoscopic excision of large and giant colorectal polyps. Technical implications and results over eight years.  Dis Colon Rectum. 1986;  29 831-835
• 3 Muto T, Bussey H J, Morson B C. The evolution of cancer of the colon and rectum.  Cancer. 1975;  36 2251-2270
• 4 Nivatvongs S, Snover D C, Fang D T. Piecemeal snare excision of large sessile colon and rectal polyps: is it adequate?.  Gastrointest Endosc. 1984;  30 18-20
• 5 Bardan E, Bat L, Melzer E. et al . Colonoscopic resection of large colonic polyps – a prospective study.  Isr J Med Sci. 1997;  33 777-780
• 6 Walsh R M, Ackroyd F W, Shellito P C. Endoscopic resection of large sessile colorectal polyps.  Gastrointest Endosc. 1992;  38 303-309
• 7 Hintze R E, Adler A, Veltzke W. Endoscopic resection of large colorectal adenomas: a combination of snare and laser ablation.  Endoscopy. 1995;  27 665-670
• 8 Binmoeller K F, Bohnacker S, Seifert H. et al . Endoscopic snare excision of ”giant“ colorectal polyps.  Gastrointest Endosc. 1996;  43 183-188
• 9 Iishi H, Tatsuta M, Iseki K. et al . Endoscopic piecemeal resection with submucosal saline injection of large sessile colorectal polyps.  Gastrointest Endosc. 2000;  51 697-700
• 10 Kanamori T, Itoh M, Yokoyama Y. et al . Injection-incision-assisted snare resection of large sessile colorectal polyps.  Gastrointest Endosc. 1996;  43 189-195