Advancing the case for combined laparoscopic–colonoscopic polyp resection?

Abstract

Dear Editors:Re: Combined laparoscopic–endoscopic resections ofcolorectal polyps: 10-year experience and follow-up. Wil-helm et al. Surg Endosc (2009) 23:688–693.This report tries to answer the question regarding thefeasibility of laparoscopically assisted resection of difficult‘‘benign’’ polyps. It would have been useful if the reporthad contextualized the data presented with regard to thenumber of patients who underwent alternative/open pro-cedures? The definition of polyps deemed unresectable bycolonoscopy is accepted as subjective, although it raises thequestion whether any screening or repeat colonoscopy wasdone by an experienced colonoscopist.Voloyiannis et al. [1] found that selective colonoscopyfor 171 of 252 referred patients led to avoidance ofresection for 101 patients. Resection was avoided for 58%of those rescoped and 40% of all referred. This resectionrate may improve with the relatively new technique ofcolonoscopic (endoscopic) mucosal resection described bySaito et al. [2].The authors are to be complimented for their honestlyappraised complication rate of 25%. The actual percentageprobably is higher because the study is retrospective in nat-ure, which leads to difficulties in determining the causes orrelevance of reported complications with the procedure. Anundeclared percentage of data is being determined bythe lead clinician or by patient recall at a later date. Havethe authors used a validated scale to classify their compli-cations? Moreover, because intraabdominal abscesses oftenresult from small leaks, do they warrant merely ‘‘minor’’status?Theinclusionofacolonoscopicfollow-upevaluationis a useful adjunct, although other trials have used 1-yearscreening to ensure no polyps were missed. Wade andBraunfeld [3] report a adenoma rate of 58% at the 1-yearcolonoscopic follow-up visit, with 9% of the cases showingadenomas larger than 10 mm, probably representing missedadenomas. In relation to the polyps found at rescoping, didthey correlate with previous resections?Overall, this is an interesting topic highlighted by theauthors, and we think this paper is a useful study that couldhave provided us with more evidence to advance the casefor combined laparoscopic–endoscopic resections.References