Outcome of An Endoscopic Mucosal Resection Service for Large Sessile Colonic Polyps (≥ 20 mm) over A 9-Year Period: A Single Centre Experience and Analysis of Change over Time in A University Teaching Hospital

Abstract

AIM: To assess the clinical outcome of a service providing colonic endoscopic mucosal resection (EMR) of polyps ≥ 20 mm at University Hospital of Leicester NHS Trust and to assess changes over a 9-year period. METHODS: Retrospective observational study, data were prospectively collected for all cases of sessile colonic polyps ≥ 20 mm that were removed via EMR by colonoscopists accredited by the Bowel Cancer Screening Programme (BCSP) between 2006 and 2014. RESULTS: 569 lesions in 564 patients were assessed for EMR; 424 lesions were successfully excised via EMR. Recurrence/residual adenoma at the EMR site was found in 56 (17%) at the first surveillance endoscopy; endoscopically treated in 53/56 (95%) patients; 3/56 (5%) were referred for surgical resection. Complete eradication at second surveillance endoscopy; 269/292 patients (92%). Recurrence in 23 (8%) patients and the recurrent lesion was endoscopically resected in 22/23 patients. The overall complication rate was 17/424 (4%). There were no procedure-related deaths. Over a 9-year period, there was a consistent reduction in the number of patients with benign polyps not treated via EMR who were instead referred for surgical resection (P = 0.003). There were increases in the numbers of EMRs completed annually (P = 0.001), mean polyp size resected (P = 0.024) and level 3 and 4 polypectomies (P <0.001). CONCLUSIONS: Endoscopic mucosa resection of large sessile polyps ≥ 20 mm by accredited Bowel Cancer Screening programme (BCSP) colonoscopits showed good quality of this EMR service over time.