4486 Polypectomy of large polyps (= 2 cm): efficacy and safety.

Abstract

Introduction: The potential for malignancy increases when adenomatous colonic polyps are larger than 2 cm. Many of these are amendable to endoscopic removal. Aim: To assess long-term efficacy and safety of colonoscopic removal of large colonic polyps. Methods: Patients with large colonic polyps (>2 cm), who underwent polypectomy were identified using the Mayo Biostatistics and GI database systems. Data obtained included: demographics, colonoscopy reports, polyp size and location, removal methods, pathology, complications, subsequent procedures, and recurrence. Results: From May 1990 to March 1999, 287 pts underwent polypectomy for 320 large polyps. One hundred seventy eight (62%) were males. Mean age was 68±2.8 yrs (32-90). Mean polyp size was 2.79±0.94 cm (2-8). Polyp location was: cecum 31 (9.7%), ascending 62 (19.4%), hepatic flexure 24 (7.5%), transverse 22 (6.9%), splenic flexure 21 (6.6%), descending 23 (7.2%), sigmoid 98 (30.6%), and rectum 39 (12.2%). One hundred seventy five (54.7%) were sessile and 141 (44%) were pedunculated. Invasive carcinoma was found in 13 polyps (4%). Four synchronous cancers (1.4%) were found, all distant to the index polyp. Initial follow-up colonoscopy after a median interval of 189 days in 138 pts (47%) revealed residual polyp at the index site in 69 (50%) which were retreated. Bleeding occurred in 6 pts (2%) with hospitalization over a mean of 8±8 days (2-30) with 1 requiring surgery. Two (0.6%) perforations occurred requiring surgery. Ten pts (3.4%) underwent surgery because of persistent polyp on follow-up colonoscopy (mean procedures 1.7±1.1, range 1-4). There was no procedure related mortality. Conclusions: 1. Polypectomy of large polyps is safe. 2. Colonoscopic removal of large polyps is desirable since only a small number (4%) of large polyps will contain invasive carcinoma. 3. Intensive follow-up with repeated therapy is warranted because of a high residual polyp rate.