Endoscopic Removal of Large Colorectal Polyps

Doniec, J. M.; Löhnert, M.; Schniewind, Bodo; Bokelmann, Frank; Kremer, Bernd; Grimm, H

doi:10.1007/s10350-004-6553-x

Cited by 123 publications

(83 citation statements)

References 22 publications

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“…In this study, we described a series of 1354 endoscopic resections of colon rectal polyps performed in our endoscopic units between January, 1996 and May, 2006. The gender and age distribution of patients is similar to that described above in other studies regarding the treatment of colorectal polyps [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . From the literature, it emerges that over 80% of polyps resected during colonoscopy are small polyps less than 10 mm in diameter [24] while in our study 67% were 10 mm in diameter.…”

Section: Discussionsupporting

confidence: 59%

“…The incidence of bleeding during and after the polypectomies has been reported to range from 0.3% to 6.1%, with higher rates in large polyps up to 22.1% (Table 6) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . In our series, the Pearson χ 2 test applied in the subgroups found a correlation between the bleeding and liver diseases (P = 0.003), which usually impairs the coagulation function of the patients and location of polyps in transverse colon (P < 0.0001), in group 2 with histology and in particular with the hyperplastic polyps (P = 0.023) and the malignancy (P < 0.0001).…”

Section: Discussionmentioning

confidence: 99%

“…The reported incidence of perforation during polypectomy of "normal-sized" polyps ranges from 0.3%-0.5% [34] , while the incidence of injury to the colon wall Brooker JC et al [3] 34 -34 17.6 0 5.9 Hsieh YH et al [4] 13 -13 0 0 0 Brooker JC et al [5] 100 -100 3 0 1 Walsh RM et al [6] 117 -117 8.5 0.8 0.8 Iishi H et al [7] 56 -56 7 0 0 Zlatanic J et al [8] 77 -77 6.5 1.3 0 Kanamori T et al [9] 33 -33 9.1 0 0 Boix J et al [10] 74 -74 13.5 0 0 Bedogni G et al [11] 66 20 42 3.1 0 1.5 Binmoeller K et al [12] 176 47 129 24 0 0 Webb WA et al [13] 102 72 30 7.8 0 0 Nivatvongs S et al [14] 280 196 84 0.7 0 1.8 Perenz RF et al [15] 147 73 74 5.4 1.3 0 Dell'Abate P et al [16] 104 49 55 3.8 0 0 Jameel JK et al [17] 30 6 24 6.1 0 0 Doniec JM et al [18] 186 45 141 15 0.5 0 Stergiou N et al [19] Table 6 Recent reports of series on large polyp endoscopic resection and our series (transmural burn, microperforation, or free perforation) in large polypectomies is 0 to 1.3% (Table 6) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . In our study, no perforation was reported in the group of large polyps while the only late perforation (0.07%) occurred, after polypectomy, in a small (15 mm) malignant sessile polyp located in the sigmoid colon and without endoscopic sign of suspected malignancy.…”

Section: Discussionmentioning

confidence: 99%

“…Large polyps represent a particular challenge for the endoscopist because they are often related to important risks of haemorrhage (0%-22.1%), perforation (0%-1.3%) and inadequate polypectomy [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . The alternative to endoscopic therapy of large polyps is the surgical resection which involves hospitalization and anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

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

Consolo¹,

Luigiano²,

Strangio³

et al. 2008

WJG

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AIM:To examine the efficacy and complications of colonoscopic resection of colorectal polypoid lesions. M E T H O D S :We r e t r o s p e c t i v e l y r e v i e w e d 1 3 5 4 polypectomies performed on 1038 patients over a tenyear 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 χ 2 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.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Consolo¹,

Luigiano²,

Strangio³

et al. 2008

WJG

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show abstract

“…Bleeding is considered the most common complication, occurring in 0.4% to 16% of cases (8,15,32,48) . Ferrara et al (10) concluded that bleeding was significantly related to malignancy, as observed in one of our cases.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic mucosal resection in colorectal lesion: a safe and effective procedure even in lesions larger than 2 cm and in carcinomas

Santos¹,

Malaman²,

Pereira-Lima

2011

Arq. Gastroenterol.

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-Context -Endoscopic mucosal resection is a minimally invasive technique used in the treatment of colorectal neoplasms, including early carcinomas of different size and morphology. Objectives -To evaluate procedure safety, efficacy, outcomes, and recurrence rate in endoscopic mucosal resection of colorectal lesions. Methods -A total of 172 lesions in 156 patients were analyzed between May 2003 and May 2009. All lesions showed pit pattern suggestive of neoplasia (Kudo types III-V) at high-magnification chromocolonoscopy with indigo carmine. The lesions were evaluated for macroscopic classification, size, location, and histopathology. Lesions 20 mm or smaller were resected en bloc and lesions larger than 20 mm were removed using the piecemeal technique.Complications and recurrence were analyzed. Patients were followed up for 18 months. Results -There were 83 (48.2%) superficial lesions, 57 (33.1%) depressed lesions, 44 (25.6%) laterally spreading tumors, and 45 (26.2%) protruding lesions. Mean lesion size was 11.5 mm ± 9.6 mm (2 mm-60 mm). Patients' mean age was 61.6 ± 12.5 years (34-93 years). Regarding lesion site, 24 (14.0%) lesions were located in the rectum, 68 (39.5%) in the left colon, and 80 (46.5%) in the right colon (transverse, ascending, and cecum). There were 167 (97.1%) neoplasms: 142 (82.5%) adenomatous lesions, 24 (14.0%) intramucosal carcinomas, and 1 (0.6%) invasive carcinoma. En bloc resection was performed in 158 (91.9%) cases and piecemeal resection in 14 (8.1%). Bleeding occurred in 5 (2.9%) cases. Recurrence was observed in 4.1% (5/122) of cases and was associated with lesions larger than 20 mm (P<0.01), piecemeal resection (P<0.01), advanced neoplasm (P = 0.01), and carcinoma compared to adenoma (P = 0.04). Conclusions -Endoscopic mucosal resection of colorectal lesions is a safe and effective procedure, with low complication and local recurrence rates. Recurrence is associated with lesions larger than 20 mm and carcinomas.

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Colon Widefield Endoscopic Mucosal Resection

Bourke

Tutticci

2015

Gastrointestinal Endoscopy

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Endoscopic Removal of Large Colorectal Polyps

Abstract: Endoscopic polypectomy is a safe and effective method of treating large colorectal polyps.

Cited by 123 publications

References 22 publications

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

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

Endoscopic mucosal resection in colorectal lesion: a safe and effective procedure even in lesions larger than 2 cm and in carcinomas

Colon Widefield Endoscopic Mucosal Resection

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