Management of the Difficult Colon Polyp Referred for Resection: Resect or Rescope?

Voloyiannis, Theodoros; Snyder, Michael J.; Bailey, H. Randolph; Pidala, Mark J

doi:10.1007/s10350-008-9400-7

Cited by 16 publications

(32 citation statements)

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“…Mean age was similar to other conducted studies, but we found that the gender distribution was different, with a predominance of female patients [7, 8]. …”

Section: Discussionsupporting

confidence: 87%

Laparoscopically assisted colonoscopic polypectomy - viable option for curative surgery in elderly patients.

Račkauskas

Mikalauskas

Petrulionis

et al. 2017

Videosurgery and Other Miniinvasive Techniques

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IntroductionColorectal cancer (CRC) is the third most common cancer worldwide and the fourth most frequent cause of cancer-related death in the world. CRC screening programs have been widely introduced worldwide, allowing for early detection and removal of precancerous lesions and avoiding major surgical intervention. However, not all polyps are suitable for conventional and advanced colonoscopic polypectomy. Thus, laparoscopically assisted colonoscopic polypectomy (LACP) was introduced to clinical practice as a method of choice for these polyps and adenomas.AimTo overlook our experience in laparoscopically assisted colonoscopic polypectomies and evaluate effectiveness and quality of the procedure.Material and methodsA retrospective analysis of a prospectively maintained database was performed. using the Vilnius University Hospital Santariskiu Klinikos patient database for the period from 2010 to 2016, resulting in 21 cases in which LACP was performed. All procedures were performed using combined laparoscopy and videocolonoscopy techniques. Morphology of adenomas was classified according to the Paris classification during the procedure. Creation of the database was approved by the Lithuanian Bioethics committee.ResultsTwenty-two adenomas were removed from 21 patients, aged 65.33 ±8.9. There was no difference between male and female age, but occurrence of adenomas in females was 2-fold higher. The majority of removed lesions were localized in the cecum and mean size was 27.2 ±11.1 mm. The morphology of adenomas was distributed equally between 0–Is, 0–Ip, and 0–IIa, except one, which belonged to 0–III. Histological analysis revealed that tubulovillous adenoma occurrence was 1.4 times higher than tubulous adenoma. There was only one postoperative complication – bleeding from the adenoma resection site, which was managed by conservative means. One patient developed G2 adenocarcinoma at the polyp resection site and was referred for radical surgery.ConclusionsThe LACP is a safe procedure with minimal risk to the elderly patient. Patient follow-up is essential for detection of recurrence.

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“…Mean age was similar to other conducted studies, but we found that the gender distribution was different, with a predominance of female patients [7, 8]. …”

Section: Discussionsupporting

confidence: 87%

Laparoscopically assisted colonoscopic polypectomy - viable option for curative surgery in elderly patients.

Račkauskas

Mikalauskas

Petrulionis

et al. 2017

Videosurgery and Other Miniinvasive Techniques

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“…In this context, it is possible to detect advanced adenomas in more than 50% of colonoscopies (22). On the other hand, it is known that referral of patients with adenomas to specialised units when resection is likely to be difficult avoids surgical treatment in 32% to 90% of cases (23)(24)(25). In this way, it is possible to reduce both morbidity and healthcare costs associated with the treatment of adenomas (24).…”

Section: Discussionmentioning

confidence: 99%

Factors associated with complete endoscopic resection of an invasive adenocarcinoma in a colorectal adenoma

Quintas

Cubiella

Couto

et al. 2012

Rev. esp. enferm. dig.

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Background and objective: endoscopic polypectomy may allow curative resection of invasive adenocarcinoma on colorectal adenoma. Our goal was to determine the factors associated with complete endoscopic resection of invasive adenocarcinoma.Methods: retrospective observational study. We included 151 patients with invasive adenocarcinoma on adenomas endoscopically resected between 1999 and 2009. We determined those variables independently related to incomplete resection by a logistic regression. Relation was expressed as Odds Ratio (OR) and its 95% confidence interval (95% CI).Results: patients were predominantly male (66.2%) and their mean age was 68.03 ± 10.65 years. Colonoscopy was complete in 84% of the patients and 60.3% had synchronous adenomas. Invasive adenocarcinoma was mainly located in distal colon (90.7%) and morphology was pedunculated in 75.5%. The endoscopic average size was 22.61 ± 10.86 mm. Submucosal injection was required in 32.5%. Finally, the resection was in one piece in 73.5% and incomplete in 8.6% of the adenocarcinomas. Factors independently associated with incomplete endoscopic resection were size (mm) (OR 1.08, 95% CI 1.03-1.14, p = 0.002), sessile or flat morphology (OR 8.78, p = 0.002) and incomplete colonoscopy (OR 4.73, p = 0.03).Conclusions: endoscopic polypectomy allows complete resection of 91.4% of invasive adenocarcinomas on colorrectal adenoma in our series. Factors associated with incomplete resection were the size of the lesion, sessile or flat morphology and incomplete colonoscopy.

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“…6 mm (this is the common diameter of an extended forceps) [14] . Larger polyps should be either cold-snared or snared with electrocautery [1,2] . The hot biopsy technique offers the potential advantage of tissue 'cauterization' and polyp elimination.…”

Section: Hot Versus Cold Biopsymentioning

confidence: 99%

“…

are flat and extended, are difficult to see or are located in the cecum or any angulated portion of the colon should be always considered difficult [1,2] . Post-polypectomy complications are more common in these situations [3][4][5][6] .

Tips and Tricks to Resect Difficult Polyps

Place Polyp in Adequate Position

Before catching and snaring a polyp it is important to place the polyp in an adequate position.

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mentioning

confidence: 99%

Polypectomy Techniques for Difficult Colon Polyps

Mönkemüller

Neumann

Fry

et al. 2008

Dig Dis

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A difficult polyp is any flat or raised colonic mucosal lesion that given its size, shape or location makes it difficult for the colonoscopist to remove. Although many ‘difficult polyps’ will be an easy target for the advanced endoscopist, polyps that are >15 mm, have a large pedicle, are flat and extended, are difficult to see or are located in the cecum or any angulated portion of the colon should be always considered difficult. Post-polypectomy complications are more common in the presence of difficult polyps. This review describes several useful tips and tricks to deal with such polyps.

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Management of the Difficult Colon Polyp Referred for Resection: Resect or Rescope?

Cited by 16 publications

References 0 publications

Laparoscopically assisted colonoscopic polypectomy - viable option for curative surgery in elderly patients.

Laparoscopically assisted colonoscopic polypectomy - viable option for curative surgery in elderly patients.

Factors associated with complete endoscopic resection of an invasive adenocarcinoma in a colorectal adenoma

Polypectomy Techniques for Difficult Colon Polyps

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