Tu1084 ENDOSCOPIC THERAPY IS EFFECTIVE AND SAFE IN THE MANAGEMENT OF COMPLEX COLORECTAL POLYPS: A SINGLE TERTIARY CARE CENTER EXPERIENCE

Abstract

Complex colorectal polyps are frequently referred for surgical resection due to associated risk of significant hemorrhage, perforation, inadequate polypectomy, or unrecognized cancer. Although minimally invasive laparoscopic techniques are available, surgical risks remain significant. To evaluate the efficacy and safety of endoscopic polypectomy (EP) for colorectal polyps >20 mm in size. Patients referred for complex colorectal polyp resection in our Advanced Endoscopy Unit between 01/2013 and 06/2019 were identified using Advanced Cohort Explorer. Data were abstracted for patient demographics, lesion size, morphology and location, resection techniques, defect closure, adverse events, and recurrence. Out of 606 patients analyzed, 417 (42% women; mean age 67±11 years) with polyps >20 mm were identified; 5% had concurrent inflammatory bowel disease and 10% had previous endoscopic attempts at polyp removal. 16% of these lesions were in challenging locations at the ileocecal valve, periappendiceal region or involving a diverticulum. Lesions were located in the rectum (9.9%), recto-sigmoid colon (6%), sigmoid colon (8.1%), descending colon 6%), splenic flexure (1.2%), transverse colon (9.6%), hepatic flexure (7.2%), ascending colon (24%), cecum (19%), appendiceal region (2.1%), ileocecal valve (6.3%), and anastomotic site (0.6%). The lesions were morphologically classified as sessile (50.1%), flat (35.5%), pedunculated (8.1%), depressed (0.6%) and undefined (5.7%). 52.1% of the lesions underwent additional therapy to snare EP, including argon plasma coagulation, cold biopsy avulsion, endoloop and hot biopsy avulsion. Prophylactic clip closure was performed in 76% of resected lesions, with average placement of 5 clips. Invasive adenocarcinoma was found in 3.3% lesions at the index resection and required curative surgical resection. Intraprocedural perforation occurred in 1.2% cases and was successfully managed by clip placement. Delayed adverse events occurred in 7.8% cases (bleeding in 6%, perforation in 0.9%, transmural burn syndrome in 0.9%). Higher rate of delayed perforation was observed for lesions > 30mm (67% of all delayed perforations). Rates of residual or recurrent disease on follow-up included: 1.8% within 12 months; 3.3% within 24 months; 0.9% within 36 months; and 2.1% after 36 months, of which 14.8% were managed by surgical resection and 85.1% underwent repeat endoscopic resection. Of those patients who underwent repeated attempt at a resection, 1.5% recurred for the second time and 0.3% recurred for the third time. In this large single-center study, endoscopic resection was safe and effective in the management of large colorectal polyps. Cost of care comparison between endoscopic and surgical approaches for these complex polyps is currently underway.Method of defect closure at resection siteView Large Image Figure ViewerDownload Hi-res image Download (PPT)