Resection Of Large Colonic Polyps Research Articles

The “Importance of Ensuring Adequate Coagulation Function” Prior to Resection of Large Colon Polyps

The “Importance of Ensuring Adequate Coagulation Function” Prior to Resection of Large Colon Polyps

Successful Complete Cure En-Bloc Resection of Large Nonpedunculated Colonic Polyps by Endoscopic Submucosal Dissection: A Meta-Analysis and Systematic Review

Endoscopic submucosal dissection (ESD) has emerged as one of the techniques to successfully resect large colonic polyps en bloc. Complete resection prevents the patient from going through transabdominal colonic resection. We sought to evaluate the proportion of successful en-bloc and complete cure en-bloc resection of large colonic polyps by ESD. Studies that use ESD technique to resect large colonic polyps were selected. Successful en-bloc resection was defined as resection of the polyp in one piece. Successful complete cure en-bloc resection was defined as one piece with histologic disease-free-margin polyp resection. Articles were searched in Medline, PubMed, and Cochrane control trial registry. Pooled proportions were calculated by both fixed and random-effects model. The initial search identified 2,120 reference articles; 389 relevant articles were selected and reviewed. Data were extracted from 14 studies (n = 1,314) that met the inclusion criteria. The mean +/- standard error size of the polyps was 30.65 +/- 2.88 mm. Pooled proportion of en-bloc resection by the random-effects model was 84.91% (95% confidence interval, 77.82-90.82) and complete cure en-bloc resection was 75.39% (95% confidence interval, 66.69-82.21). The fixed-effects model was not used because of the heterogeneity of studies. ESD should be considered the best minimally invasive endoscopic technique in the treatment of large (>2 cm) sessile and flat polyps because it allows full pathological evaluation and cure in most patients. ESD offers an important alternative to surgery in the therapy of large sessile and flat polyps.

Predictors of Successful Endoscopic Polypectomy of Large Colon Polyps

Background: Ability to predict successful endoscopic resection of large colon polyps based on endoscopic characteristics of the polyps will be helpful in guiding optimal management of these patients. Aim: To identify the predictors of successful endoscopic resection of large colon polyps. Methods: Patients with large colon polyps (> 20mm) were identified from the endoscopy database of our institution from 2002 to 2007. Patient charts were reviewed for information on demographic features, co-morbidities, polyp characteristics, polypectomy techniques, and surgical interventions.

Impact of Endoscopist's Experience On Success Rate of En-Bloc and En Bloc-Cure of Large Colorectal Polyps By Endoscopic Submucosal Dissection: A Meta-Analysis and Systematic Review

Impact of Endoscopist’s Experience On Success Rate of En-Bloc and En Bloc-Cure of Large Colorectal Polyps By Endoscopic Submucosal Dissection: A Meta-Analysis and Systematic Review Srinivas R. Puli, Yasuo Kakugawa, Takuji Gotoda, Jyotsna Bk Reddy, Daphne Antillon, Yutaka Saito, Mainor R. Antillon Background: Endoscopic submucosal dissection (ESD) has emerged as an alternative to surgery for the resection of large (O 2 cm) colorectal polyps. ESD is a technically demanding procedure. From published data, it is not clear how endoscopists’ experience affects successful en-block resection of large colonic polyps. Aim: To evaluate how endoscopists experience in performing ESD affects the proportion of successful en-block resection of large colonic polyps. Method: Study Selection Criteria: Studies using ESD technique to resect large colonic polyps were selected. Successful cure en-block resection was defined as margins free polyp resection. Data collection & extraction: Articles were searched in Medline, Japanese language literature, and Cochrane control trial registry. Two reviewers independently searched and extracted data. Statistical Method: Summary estimates are expressed as pooled proportions. Studies were grouped into !100 ESD’s performed and O 100 ESD’s performed. First, the individual study proportions of successful resection are transformed into a quantity using Freeman-Tukey variant of the arcsine square root transformed proportion. The pooled proportion is calculated as the back-transform of the weighted mean of the transformed proportions, using inverse arcsine variance weights for the fixed effects model and DerSimonian-Laird weights for the random effects model. Results: Initial search identified 2,120 reference articles, in which, 389 relevant articles were selected and reviewed. Data was extracted from 13 studies (N Z 1,080) which met the inclusion criteria. 9 Studies had !100 ESD’s (N Z 394) and 4 studies had O100 ESD’s (N Z 686). The mean size of the polyps was 30.65 SE 2.88 mm. The pooled proportions are shown in table 1. The fixed effect model was not used because of the heterogeneity among studies. The publication bias calculated by BeggMazumdar bias indicator for successful en-bloc resection gave a Kendall’s tau b value of -0.22 (p Z 0.32) and the same for successful cure en-block resection was -0.23 (p Z 0.25). Conclusion: ESD is an innovative technique for resection of large colonic polyps that offers an alternative to surgery. Our meta-analysis shows that the success rate for both en-bloc and en-bloc cure improves with O100 ESDs. Endoscopist’s experience significantly improves the success rates of this technique to treat large colorectal polyps.

Successful Complete CURE En-Bloc Resection of Large Colonic Polyps By Endoscopic Mucosal Or Submucosal Resection: A Meta-Analysis and Systematic Review

Successful Complete CURE En-Bloc Resection of Large Colonic Polyps By Endoscopic Mucosal Or Submucosal Resection: A Meta-Analysis and Systematic Review

Insulated-Tip Knife Endoscopic Mucosal Resection of Large Colorectal Polyps Unsuitable for Standard Polypectomy

Endoscopic mucosal resection (EMR) has been shown to be safe and effective. En bloc resection is often not achieved using conventional EMR. Insulated-tip knife (It-knife) EMR has been recently proposed for early gastric cancer dissection and removal. This study was conducted to evaluate the safety and efficacy in obtaining en bloc resection with It-knife EMR of large colonic lesions not resectable with standard endoscopic techniques. A total of 29 patients (19 men, 10 women, mean age 67.5 yr, range 44-88) were included in the study. Lesions were considered not suitable for standard polypectomy because of large diameter (>3 cm), morphology, and/or position. Lesions were located in the rectum (N = 11), sigmoid: (N = 10), descending: (N = 4), transverse: (N = 2), and hepatic flexure (N = 2). After saline injection, circumferential incision and dissection of the lesions were attempted with the aim of achieving en bloc resection. En bloc resection was achieved in only 55.1% of the lesions (16 out of 29 patients). In the remaining cases, resection was completed with a piecemeal technique. The median size of the en bloc resected specimen was 3 x 3.4 cm. Complications occurred in four patients (13.7%). At histopathology, 13 patients had low-grade dysplasia, 15 high-grade dysplasia. One patient had a tumor invading the submucosa and was submitted to surgery. It-knife EMR is a promising technique for attempting en bloc resection of large colonic polyps. Adequate training and caution are required because it can be associated with a higher complication rate than with other EMR modalities.

Polypectomy devices

Polypectomy devices

Endoscopic snare resection of large colonic polyps: how far can we go?

Colonoscopic polypectomy is preventing colorectal cancer. Videoendoscopy and new perendoscopic hemostasis techniques make endoscopic polypectomy of large colonic polyps an alternative to the surgical approach. This study examined whether complete snare resection of giant colonic polyps is feasible and safe and for determining how often surgery is necessary due to invasive cancer detected histologically after polypectomy. The study included 59 consecutive patients with 68 colonic polyps larger 30 mm in diameter. Snare polypectomy was performed after an endoscopic ultrasound with a miniprobe found no sign of invasive, or, depending on the appearance of the polyp, a bleeding prophylaxis had been carried out. Acute procedural or delayed bleeding was treated endoscopically. Of the 68 polyps 26, mostly pedunculated were resected en bloc (38%) and histologically ensured as completely resected; 42 polyps had to be resected by piecemeal technique (62%). Piecemeal resection was performed significantly more often in sessile polyps (38/41, 93%) than in pedunculated polyps (4/27, 15%, P<0.01). Follow-up colonoscopy after 3 months showed remaining adenomatous tissue of piecemeal-resected polyps in 12 cases (28%), which were 12 resected sessile polyps (29%) and no case of resected pedunculated polyp. To achieve complete resection of sessile polyps a second procedure was necessary significantly more often than for resection of pedunculated polyps (12 cases in sessile polyps, 18% vs. no case in pedunculated polyps). Remaining adenomatous tissue was removed in all 12 cases during the first follow-up colonoscopy after 3 months, confirmed by a biopsy 6 months after the initial procedure. Overall coexisting malignancy was found in only 7 polyps (12%). Due to high-risk factors only one of them underwent secondary surgical procedure. The present study shows that endoscopic snare resection of giant colonic polyps is a safe procedure, and that secondary operative measures for managing coexisting malignancy are rarely necessary.