title: Endoscopic piecemeal resection with submucosal saline injection of large sessile colorectal polyps.
abstract: BACKGROUND
  Because endoscopic en bloc resection of large, sessile colorectal polyps is technically difficult, they are usually resected piecemeal. However, piecemeal resection makes it difficult to evaluate the completeness of the resection histopathologically. In this study the efficacy of endoscopic piecemeal resection of large, sessile colorectal polyps was investigated after follow-up greater than 1 year.
  
  
  METHODS
  We removed 56 sessile colorectal polyps 2 cm or greater in diameter in 56 patients by using an endoscopic submucosal saline injection technique. Endoscopic examinations were repeated at 3, 6, and 12 months and longer after initial endoscopic resection. If no residual tumor was found endoscopically and histologically, the patient was considered to be "cured."
  
  
  RESULTS
  Of the 56 polyps, 14 (25%) were resected en bloc, and 42 (75%) were resected piecemeal. Of the 42 patients treated with piecemeal resection, 23 (55%) required additional endoscopic or surgical interventions. In patients followed 1 year or longer after initial treatment, the cure rate by en bloc resection was 100% (14 of 14) and that by piecemeal resection was 83% (35 of 42). Arterial bleeding occurred in 4 patients (7%) during or after endoscopic resection. In 3 of them, bleeding was stopped by endoscopic clipping, but 1 patient required emergent laparotomy.
  
  
  CONCLUSIONS
  Endoscopic piecemeal resection after submucosal saline injection with an intensive follow-up program is a safe and effective treatment for large, sessile colorectal polyps.
authors.affiliation: Department of Gastroenterology and Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Iishi
authors.forename: M
authors.initials: M
authors.lastname: Tatsuta
authors.forename: K
authors.initials: K
authors.lastname: Iseki
authors.forename: H
authors.initials: H
authors.lastname: Narahara
authors.forename: N
authors.initials: N
authors.lastname: Uedo
authors.forename: N
authors.initials: N
authors.lastname: Sakai
authors.forename: H
authors.initials: H
authors.lastname: Ishikawa
authors.forename: T
authors.initials: T
authors.lastname: Otani
authors.forename: S
authors.initials: S
authors.lastname: Ishiguro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012965:Sodium Chloride
chemical_list: D012965:Sodium Chloride