Outcomes of repeat colonoscopy in patients with polyps referred for surgery without biopsy-proven cancer

Volume of surgery for benign colorectal polyps in the last 11 years

“…When performed by experienced endoscopists, over 90% of all large complex colorectal polyps can be removed by ER. 10,13,36,37 In the study by Friedland et al, 13 71% of advanced colonic lesions without biopsy-proven CRC, already referred for SR, could be treated by ER during a repeat colonoscopy performed in a tertiary center performed by an experienced endoscopist. SR could therefore directly be avoided in these patients.…”

“…10 Replacing SR with ER will reduce surgical morbidity, mortality, and costs. 5,[9][10][11][12][13][14][15] It remains largely unknown to what extent ER has replaced SR. We therefore performed a multicenter, retrospective cohort study in the Netherlands to assess the total volume of colorectal surgery for benign colorectal polyps and the absolute and relative volume changes over the past decade. We also assessed the endoscopic characteristics of the resected lesions, surgical characteristics, and surgery-related morbidity and mortality.…”

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

“…Surgery undoubtedly has a major role in the management of complex polyps where there is a high clinical suspicion of malignancy, but guidelines recommend surgery as a second-line option in the initial treatment of benign appearing lesions [14]. There is good evidence that, for polyps deemed unsuitable for endoscopic resection at initial assessment, the need for surgery could be reduced in a reasonable proportion of patients if referred for endotherapy at centres with appropriate clinical expertise [27][28][29]. We have demonstrated in this heterogeneous multicentre study that 87% of endoscopically resected polyps were managed successfully without undergoing secondary surgery.…”

Knife-assisted snare resection (KAR) of large and refractory colonic polyps at a Western centre: Feasibility, safety and efficacy study to guide future practice

“…We believe that conventional EMR in these polyps would have resulted in high recurrence rates of up to 20%-50% as reported in other Western series. 12,13 Full ESD in the Western setting would have resulted in very high complication rates as reported in the French series. 14 The polyps included in this series were all tertiary referrals from other endoscopists who could not resect them due to the size (20-170 mm), difficult access, flat morphology or extensive scarring and fibrosis (22% of the cases).…”