Management Of Large Colorectal Polyps Research Articles

Endoscopic techniques for management of large colorectal polyps, strictures and leaks

The implementation of screening colonoscopy with polyp removal has significantly decreased mortality rates associated with colorectal cancer (CRC), although it remains a major cause of cancer-related deaths globally. CRC typically originates from adenomatous polyps, and increased removal of these growths has led to reduced CRC incidence and mortality. Endoscopic polypectomy techniques, including hot and cold snare polypectomy, play a pivotal role in this process. While both methods are effective for small polyps (<10 mm), recent evidence favors cold snare polypectomy due to its superior safety profile and comparable complete resection rates. Large polyps (>10 mm), particularly those with advanced features, pose increased cancer risks and often require meticulous assessment and advanced endoscopic techniques, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), for resection.This chapter also provides a practical overview of endoscopic techniques for managing colonic obstructions and pericolonic fluid collections, detailing their indications, advantages, disadvantages, and complications. The goal is to improve understanding and application in clinical practice. Additionally, we provide a summary of endoscopic closure techniques that have revolutionized the management of perforations and fistulas, offering safe and effective alternatives to surgery.

S0914 Efficacy of Underwater Endoscopic Mucosal Resection vs Conventional Endoscopic Mucosal Resection for Management of Large Colorectal Polyps: A Systematic Review and Meta-Analysis

S0914 Efficacy of Underwater Endoscopic Mucosal Resection vs Conventional Endoscopic Mucosal Resection for Management of Large Colorectal Polyps: A Systematic Review and Meta-Analysis

Effect of implementing a regional referral network on surgical referral rate of benign polyps found during a colorectal cancer screening program: A population-based study

Surgical management is too often performed as the first-line treatment for large, benign colorectal polyps. We report the management of benign lesions detected by organised colorectal cancer (CRC) screening. Population-based study in 2012, 2016, and 2017, analyzing the evolution of surgical management of benign polyps of≥2cm diameter discovered in the context of organised CRC screening after the implementation of a regional referral network for the management of superficial colorectal lesions. A total of 1571 patients underwent colonoscopy following a positive test during the study period, among which 981 colonoscopies yielded at least one lesion. The adenoma detection rate was lower in 2012 (Guaiac test) than in 2016 and 2017 (fecal immunochemical test) (40% vs. 60% vs. 57%, P<0.0001). The surgery rate for benign lesions decreased from 14.6% in 2012 to 7.7% in 2016 and 5% in 2017 (P=0.017). The risk factors for surgery for benign lesions were year 2012 (odds ratio [OR]=3.35, P=0.022), high-grade dysplasia (OR=2.49, P=0.04), in situ carcinoma (OR=5, P=0.003), size≥20mm (OR=17.39, P<0.0001), and private sector (OR=6.6, P=0.0002). The morbidity rate of surgery for benign polyp≥2cm was 20.4% at 1month and its cost was sixfold higher than that of endoscopy. The establishment of a regional referral network for the management of large colorectal polyps reduces the rate of surgical management of such lesions.

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

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)

Endoscopic piecemeal resection of large colorectal polyps with long-term followup

Colonoscopic removal of large colorectal polyps is challenging and requires advanced endoscopic technique. Successful endoscopic management not only avoids the morbidity of surgery but also risks perforation, hemorrhage, and recurrence. This study is a retrospective review of a prospectively maintained database of all patients undergoing cautery snare piecemeal polypectomy for large colorectal polyps by a single operator over 20years with long-term followup. 231 patients underwent 269 piecemeal polypectomies over a 20year period. The complication rate was 4.3%. Malignancy was identified in 25 (10.8%) of patients. Local recurrences occurred in 24% of patients with benign adenomas. The vast majority of these were managed with repeat endoscopy. Overall, benign large polyps were managed successfully endoscopically in 94.4% of patients. Piecemeal polypectomy is effective and safe for the management of large colorectal polyps. With long-term followup, the recurrence rate is appreciable, but most recurrences can be successfully managed with further endoscopic intervention. More complex techniques such as endoscopic submucosal dissection are usually unnecessary.

Sa1107 Endoscopic Management of Large Colorectal Polyps: Safety and Effectiveness at a Large-Volume Center

Sa1107 Endoscopic Management of Large Colorectal Polyps: Safety and Effectiveness at a Large-Volume Center

Endoscopic Management of Large Colorectal Polyps Referred for Surgical Resection

Endoscopic Management of Large Colorectal Polyps Referred for Surgical Resection

Endoscopic management of large colorectal polyps

The optimal treatment for large colorectal polyps (LCPs) is still a controversial issue. The aim of this study was to evaluate the safety and effectiveness of endoscopic polypectomy (EP) of colorectal polyps >or=2 cm in size. One hundred fifty-one EP LCPs were performed over a period of 7 years. Diathermal snare was used for pedunculated and pseudopedunculated polyps and endoscopic mucosal resection (EMR) or biopsy forceps polypectomy for sessile and flat polyps. The resected polyps were recovered and collected for histology. At scheduled follow-up visits 1, 3, 6, and 12 months after polypectomy, complications and recurrences were recorded in all patients. Fifteen polyps were located in the rectum, 84 in the sigmoid colon, 11 in the descending colon, four in the splenic flexure, 11 in the transverse colon, 11 in the hepatic flexure, seven in the ascending colon and eight in the cecum. Fifty-six polyps were sessile, 54 pedunculated, 25 pseudopedunculated, and 16 flat. At histology, most of polyps (131) were adenomas (nine with adenocarcinoma in situ). Five were invasive polypoid carcinomas and required colonic resection. Immediate bleeding occurred in ten patients (7.6%) and it was stopped by endoscopic hemoclips (7), epinephrine injection (1), or surgery (2). There were three perforations (2.3%; all polypoid carcinomas), managed endoscopically (1) or surgically (2). Delayed bleeding occurred in two patients (1.5%) and was treated by endoscopic diathermy and hemoclips (1) or surgery (1). During follow-up, six (4.6%) incompletely excised polyps and three (2.3%) relapses in the site of previous EP were detected and endoscopically removed. EP is relatively safe and effective for benign-appearing LCPs.

Endoscopic mucosal resection for the management of large colorectal polyps: Our experience

Endoscopic mucosal resection for the management of large colorectal polyps: Our experience