A Retrospective Analysis of Large Polypectomies Using a Methylene Blue/Epinephrine/Saline Lift Technique

Abstract

Purpose: To retrospectively evaluate the technical success and complication rates of endoscopic polypectomy of large polyps using a methylene blue/epinephrine/saline lift technique. Background: Large colonic polyps may present a management challenge. A small but significant risk of colonic perforation, hemorrhage or incomplete polypectomy must be weighed against the inherent risks of surgery. Endoscopic snare resection of large polyps using a methylene blue/epinephrine lift technique may present a minimally invasive alternative to surgery. This may improve identification of polyp margins making assessment of complete excision easier. Methods: A retrospective series of 32 patients was analyzed. All patients underwent endoscopic resection of large polyps (>20mm) using the above technique. Polypectomies were performed by two experienced endoscopists (JML, GB and KB) at our institution (2003 to present). Backup by an experienced laparoscopic surgeon (DEML) was available for all cases. Results: Thirty-one large polyps were endoscopically removed from 30 patients. The remaining two patients were sent directly for laparoscopic resection after the polyp failed to lift. The mean age of the patients was 65 years with 47% being male. Nineteen polyps were found on the right side of the colon (7 in the cecum). Thirty-one percent of the polyps revealed either high-grade dysplasia or adenocarcinoma with average size being 33.8mm as deemed endoscopically. Six patients underwent surgery (4 laparoscopically). In 2 patients, whose polyps failed to lift, surgical pathology revealed invasive adenocarcinoma. Of the remaining 4 patients, 3 had no residual adenomatous tissue in the resected specimen. There were 2 complications. One patient had a post-polypectomy bleed which was endoscopically managed, and the other patient presented with abdominal pain with portal-venous air which resolved with conservative management. Conclusions: Large polypectomies were safely performed with a methylene blue/epinephrine/saline lift technique in this retrospective series. This technique allows for improved endoscopic delineation of polyp margins. Methylene Blue/Epinephrine/Saline Lift Technique with laparoscopic surgical back-up may, therefore, present a minimally invasive alternative to surgical resection of large polyps.