907 Endoscopic Resection of Subtotal and Complete Circumferential Colonic Advanced Mucosal Neoplasia

Abstract

Colorectal cancer (CRC) morbidity and mortality is reduced by colonoscopy and polypectomy. The majority of polyps encountered at colonoscopy are diminutive in size and readily removed with conventional snare polypectomy. Although large laterally spreading tumors (LSTs) are uncommon they represent a significant risk of progression to invasive disease and can be safely and effectively treated endoscopically with a favourable morbidity and cost profile when compared to surgical resection. Endoscopic mucosal resection (EMR) is an established effective outpatient treatment modality for colonic advanced mucosal neoplasia (AMN - sessile or flat lesions ≥ 20mm in size) without submucosal invasive adenocarcinoma. Subtotal and circumferential colonic involvement by AMN is uncommon and data on technical success rates and outcomes for lesions of this extent, is limited. Advances in endoscopic resection technique and management of adverse outcomes have been made in recent years. Theoretically there is no upper size limit to which piecemeal EMR can be applied. Herein we present a series of five extensive colonic LSTs with long term follow up. The video demonstrates resection techniques and management of adverse events. In addition to the recognised EMR adverse events, bleeding and deep injury, luminal stenosis can result from both subtotal and complete circumferential resection mandating a pre-emptive post resection endoscopic balloon dilation regimen.