Frequency of and risk factors for the surgical resection of nonmalignant colorectal polyps: a population-based study

Roy, Florence Le; Manfrédi, Sylvain; Hamonic, Stéphanie; Piette, Christine; Bouguen, Guillaume; Riou, Françoise; Bretagne, Jean–François

doi:10.1055/s-0034-1392976

Cited by 36 publications

(40 citation statements)

References 30 publications

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“…Referral to surgery for benign polyps >20 mm in size is dependent on the endoscopist and can vary from 0 to 46.6 % per endoscopist. 20 More than 75% of patients with complex colon polyps referred to our EMR center have undergone successful endoscopic resection of their polyps and thereby avoided surgery; about 24% referred to our center have had to undergo primary surgery. Luigiano et al reported similar outcomes, further substantiating the need for referral to an EMR center to avoid unnecessary surgery.…”

Section: Discussionmentioning

confidence: 99%

Outcome of EMR as an alternative to surgery in patients with complex colon polyps

Raju

Lum

Ross

et al. 2016

Gastrointestinal Endoscopy

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Background and Aims Patients with complex colon polyps were traditionally referred for surgery to avoid adverse events associated with endoscopic resection. Recent advances in endoscopic imaging as well endoscopic hemostasis and clip closure allow for the use of endoscopic mucosal resection (EMR) as an alternative to surgery for such lesions. To determine the outcome of treatment of complex colon polyps with EMR as an alternative to surgery, we conducted a retrospective observational study. Methods Two hundred three patients with complex colon polyps referred to an EMR center as an alternative to surgery. Patients underwent a protocol driven EMR.. The primary endpoint was the complete resection rate. Secondary endpoints were safety, residual adenoma rate, and incidence of missed synchronous polyps. Results EMR was performed in 155 patients and was deferred in 48 patients who were referred to surgery. EMR specimens revealed benign polyps in 149 and cancer in 6 patients. EMR adverse events occurred in seven patients, requiring hospitalization in five of them. None of the patients died of their adverse events. Surveillance colonoscopy at 4-6 months after resection of a benign lesion in 137 patients revealed residual adenoma at the scar site in 6 patients and additional synchronous precancerous lesions in 117 patients that were not removed by the referring endoscopist. None underwent surgery for failure of EMR. The overall precancerous lesion burden was 2.83 per patient, the adenoma burden was 2.13 per patient, and the serrated polyp burden was 0.69 per patient. Conclusions EMR can be used instead of surgery for complex colon polyps in 75 percent of patients with few adverse events and few residual adenomas at resection sites. In addition, careful repeat examination of the entire colon for synchronous lesions overlooked by the referring endoscopist is required for the majority of patients.

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Section: Discussionmentioning

confidence: 99%

Outcome of EMR as an alternative to surgery in patients with complex colon polyps

Raju

Lum

Ross

et al. 2016

Gastrointestinal Endoscopy

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“…In addition, a population‐based study which reported a surgical resection rate of 21% for benign polyps ≥ 20 mm in size highlighted that the diagnosing endoscopist was an important factor in the variation in surgical referral rates. This is consistent with the finding that the specialty of the endoscopist is strongly associated with the accuracy of polyp characterization and treatment recommendations .…”

Section: Discussionmentioning

confidence: 99%

Variations in the management of significant polyps and early colorectal cancer: results from a multicentre observational study of 383 patients

et al. 2018

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“…However, there are very few reports on outcomes of lesions at the extremes of the spectrum of ER, such as those with extensive or complete circumferential involvement which in the past were routinely referred for surgery. Defining these outcomes is all the more important given that, even in the current era of advanced ER, patients with large colorectal lesions without invasive cancer are still subjected to radical surgery [7,15]. Almost all reports on outcomes of ER resulting in near or total circumferential defects and the risk of stenosis originate from Japanese expert centres focusing solely on ESD, some focusing exclusively on rectal tumours [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic resection of colorectal circumferential and near-circumferential laterally spreading lesions: outcomes and risk of stenosis

Emmanuel

Ghosh

Lapa

et al. 2019

Int J Colorectal Dis

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Purpose Almost any colorectal superficial neoplastic lesion can be treated by endoscopic resection (ER) but very little is known about outcomes of ER leaving circumferential or near-circumferential mucosal defects. We report the outcomes of ER leaving ≥ 75% circumferential mucosal defects performed in a western expert centre. Methods Five hundred eighty-seven ERs of large colorectal lesions ≥ 20 mm were grouped according to the extent of the mucosal defect and comparisons made between those with < 75% and ≥ 75% defects. Independent predictors of stenosis were identified. Results Forty-seven patients had ER leaving ≥ 75% circumference defect, most located at or distal to the rectosigmoid, with ≥ 90% defects in 5 and 100% in 11. There were no significant colonic muscle injuries in patients with ≥ 75% defect and no differences in post-procedure bleeding (OR 1.6, 95% CI 0.2-13.7, p = 0.64) between patients with ≥ 75% and < 75% defects. Stenosis developed in 9 patients. ≥ 90% circumference defect was the only independent risk factor for stenosis (OR 286, p < 0.001). Three of 4 patients with asymptomatic stenosis had successful expectant management. The remainder were treated with dilatation. Recurrence was more likely in those with ≥ 75% defect (OR 7.9, 95% CI 3.8-16.4, p < 0.001) but was managed with further ER in all but 2 cases. Conclusion ER of colorectal lesions resulting in defects ≥ 75% of the luminal circumference is challenging but safe and effective when performed in an expert centre. The only independent predictor of stenosis is ≥ 90% circumference defect but some patients improve with expectant management; therefore, pre-emptive intervention may not be warranted.

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Frequency of and risk factors for the surgical resection of nonmalignant colorectal polyps: a population-based study

Cited by 36 publications

References 30 publications

Outcome of EMR as an alternative to surgery in patients with complex colon polyps

Outcome of EMR as an alternative to surgery in patients with complex colon polyps

Variations in the management of significant polyps and early colorectal cancer: results from a multicentre observational study of 383 patients

Endoscopic resection of colorectal circumferential and near-circumferential laterally spreading lesions: outcomes and risk of stenosis

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