Endoscopic Treatment of Sessile Colorectal Polyp

Abstract

Background: Endoscopic resection of sessile colonic polyps’ presents a number of unique challenges. Large sessile polyps are associated with the greatest risk of postpolypectomy bleeding, perforation and polyp recurrence, with massive submucosal scarring making subsequent attempts at endoscopic resection problematic. Objective: This study aimed to evaluate feasibility, safety, and the effectiveness of endoscopic treatment of colorectal benign-appearing polyps. Patients and methods: This prospective study was carried out on forty (40) consecutive patients at General Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt between January 2014 and August 2016. All patients were subjected to clinical evaluation including history taking, general examination, abdominal and per-rectal examinations. Results: Of the 40 cases with removed polyps, 10 cases were excised by cold biopsy forceps, 4 cases were excised by cold snare, 12 cases were excised by hot snare and 14 cases were excised by EMR with mucosal lifting according to the size of the polyp. Complications included nonspecific abdominal pain in 5 patients (12.5%) that were treated conservatively and bleeding in 3 (7.5%), two cases during procedure while 1 case presented 7 th day post procedure. One case transferred into open surgery due to perforation. All cases were treated endoscopically. Post-polypectomy surveillance permitted the detection and treatment of recurrent polyps in 3 cases that treated endoscopically with piece meal excision. Conclusion: This study showed that polypectomy of benign sessile colorectal polyps performed by an expert endoscopist is feasible, effective, and safe, even on an outpatient basis.