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

Abstract

Repeat colonoscopy by an experienced surgeon leads to complete removal and avoidance of major colectomy in 58 percent of these cases. Patients with large difficult polyps referred for resection should be considered for repeat colonoscopy before surgery.

Endoscopic management of colonoscopic perforations (with videos)

“…It is important to decide whether it is better to refer to endoscopists with expertise in the endoscopic resection or undertake the resection if it could be done safely. 87,88 Referral without biopsy. If a decision is made to refer, defer biopsies, because they cause submucosal fibrosis, which prevents subsequent adequate lifting and the ability to successfully resect the lesion.…”

Large refractory colonic polyps: is it time to change our practice? A prospective study of the clinical and economic impact of a tertiary referral colonic mucosal resection and polypectomy service (with videos)

“…Issues of safety, incomplete resection, and recurrence mean that many patients are referred for surgical management in preference to endoscopic treatment. 4,5 However, the majority of these lesions are benign, and, thus, if endoscopic resection were a viable option, substantial cost savings and clinical gains might be anticipated. This study was undertaken to assess the clinical and economic impact of a tertiary referral colonic mucosal resection and polypectomy service (TRCPS).…”

Can Magnification Endoscopy Detect Residual Adenoma After Piecemeal Resection of Large Sessile Colorectal Lesions to Guide Subsequent Treatment? A Prospective Single-Center Study

“…7 Such lesions are frequently referred for resection, although preoperative repeat colonoscopy by an experienced operator leads to complete removal and avoidance of unnecessary colectomy in 33 to 58% of these cases. [17][18][19] A significant problem in previous series dealing with piecemeal removal of such large lesions has been the high rates of adenoma recurrence, despite apparent complete endoscopic resection, where remnant adenomatous tissue represents a continuing risk for progression to carcinoma, 4,5,7 requiring additional endoscopic interventions in up to 50% of the cases. 7 Therefore, a key interventional point for improving the outcome of piecemeal resection would be the inclusion of an accurate technique that provides the endoscopist with immediate information as to DISEASES OF THE COLON & RECTUM VOLUME 52: 10 (2009) whether the resection is complete or additional treatment is needed to complete the endoscopic procedure.…”