Endoscopic mucosal resection of 161 cases of large sessile or flat colorectal polyps

Background and Study Aims: The study examines the outcomes of the ‘inject and cut’ endoscopic mucosal resection (EMR), for large sessile and flat colorectal polyps. Patients and Methods: Between January 2006 and December 2008 all patients referred to our institution for EMR of large polyps were prospectively evaluated. The accuracy of lifting sign and the rate of en bloc and piecemeal resection, complications and recurrence were analyzed. Results: A total of 157 patients with 182 lesions (median size 24.7 ± 10.2 mm) were included in the study. The most frequent location was the sigmoid colon in 30.2%. Because of non-lifting sign, 5/182 lesions were referred to surgical resection and 177 (43 flat and 134 sessile) were resected, 79 (44.6%) en bloc and 98 (55.4%) piecemeal. There were 20 procedural (11.3%) and 2 late (1.1%) bleeding, 4 post-polypectomy syndrome (2.2%) and 2 perforations (1.1%). Bleeding was related to malignancy (p = 0.01). Intramucosal cancer was observed in 5 cases (2.8%) while invasive cancer was seen in 8 (4.5%). Malignancy was related to polyp size ≧30 mm (p = 0.002). Follow-up colonoscopy was performed in 147 patients with 172 EMR for a mean of 19.8 months. Recurrence was observed in 12/172 (6.9%) polyps. Conclusion: Inject and cut EMR is practical and effective with a low risk of complication and local recurrence.

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“…The rate of bleeding observed is similar to that reported in the literature [6,17,18,19,20,21,22,23,24,25,26,27,28,29,30]. …”

Section: Discussionsupporting

confidence: 79%

“…The high frequency of local recurrence (up to 46%) after endoscopic resection for large colorectal tumors is a serious problem and an endoscopic follow-up is essential [6,7,17,18,19,20,21,22,23,24,25,26,27,28,29,30,34,35]. …”

Section: Discussionmentioning

confidence: 99%

Efficacy, Safety and Outcomes of ‘Inject and Cut’ Endoscopic Mucosal Resection for Large Sessile and Flat Colorectal Polyps

Ferrara

Luigiano²,

Ghersi³

et al. 2010

Digestion

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“…All patients in the present study had follow-up upper and lower gastrointestinal endoscopy. A wide range of recurrence rates after EMR of colorectal polyps and gastric polyps has been previously reported: between 0% and 46% [15][16][17]30,20]. In the present study, our recurrence rate was 3.4% for gastrointestinal precancerous lesions.…”

Section: Discussionsupporting

confidence: 65%

“…The most frequently reported adverse complication of EMR is bleeding, occurring in 1% to 45% of all cases [13][14][15][16][17] and the perforation rate has been reported as between 0.7% and 4% [3,18,19]. Our complication rate (intraprocedural bleeding) in this present study was 1.7%.…”

Section: Discussionmentioning

confidence: 46%

“…However, the complication rate associated with EMR is low [12]; the most frequent adverse effect is bleeding [13][14][15][16][17], followed by perforation [3,18,19], as well as recurrence [15][16][17]20]. Consequently, the use of EMR for gastrointestinal precancerous lesions has become increasingly popular in Western countries and has been found to be a safe and efficient treatment.…”

Section: Introductionmentioning

confidence: 99%

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The role of endoscopic mucosal resection in gastrointestinal precancerous lesions

Orman¹,

Gültekin²

2017

Marmara Medical Journal

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Gastrointestinal prekanseröz lezyonlarda endoskopik mukozal rezeksiyonun rolü ÖZ Amaç: Gastrointestinal maligniteler ve prekanseröz lezyonlarda endoskopik mukozal rezeksiyon (EMR) yaygın olarak kullanılmaktadır. Bu çalışmada amacımız gastrointestinal prekanseröz lezyonların tedavisinde EMR'un etkinliğini değerlendirmektir.Araç ve Gereçler: Binbeşyüz onsekiz hasta retrospektif olarak incelendi. Toplamda 59 hastaya EMR uygulandı. Lezyonlar 20 mm'den büyük ve 20 mm ve küçük olmak üzere 2 gruba ayrıldı. Mukozal görünüş ( Kudo pit patern yapısı) ve Paris sınıflamalarına göre lezyonlar kaydedildi. Hastalardan iki işlem denemesine rağmen polipleri tam çıkarılamayanlar cerrahiye yönlendirildi ve bu çalışmaya alınmadı. Yakın takipler esnasında saptanan tekrarlar kaydedildi.Bulgular: Elli dokuz hastadan toplam 94 polip rezeke edildi. Hastaların 42 ( %71,2)' sine enblok, 17 (%28,8 )'sine ise piecemeal rezeksiyon uygulandı. İki yöntem arasında yaş, cinsiyet, histopatoloji, komplikasyonlar, tekrar ve makroskobik tipler açısından farklılık gözlenmedi (P>0,05). 20 mm'den büyük poliplerde Kudo tip 4 görünüş ve adenomatöz polipler (P=0,001) yaygın olarak izlendi (P=0,03).Sonuçlar: Prekanseröz lezyonlarda EMR işlemi düşük komplikasyon ve kabul edilebilir tekrar oranları ile güvenli ve kullanışlı bir işlemdir. Kudo pit patern yapısı kanser riski değerlendirilmesinde rutin olarak kullanılmalıdır.

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Partial-Thickness Excision

Cataldo

Mortensen²

2008

Transanal Endoscopic Microsurgery

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Endoscopic mucosal resection of 161 cases of large sessile or flat colorectal polyps

Abstract: With careful attention to technique, piecemeal EMR is a safe option for the resection of most sessile and flat colorectal polyps >or=20 mm in size. A stricter follow-up may be required for larger lesions because of a higher risk of recurrence.

Cited by 97 publications

References 28 publications

Efficacy, Safety and Outcomes of ‘Inject and Cut’ Endoscopic Mucosal Resection for Large Sessile and Flat Colorectal Polyps

Efficacy, Safety and Outcomes of ‘Inject and Cut’ Endoscopic Mucosal Resection for Large Sessile and Flat Colorectal Polyps

The role of endoscopic mucosal resection in gastrointestinal precancerous lesions

Partial-Thickness Excision

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