Endoscopic removal of large colorectal polyps: prevention of unnecessary surgery?
OBJECTIVE
Because of the potential risk of malignancy and technical difficulties in achieving complete removal, large colorectal polyps represent a special problem for the endoscopist. The aim of this study was to evaluate the capabilities and risks of endoscopy in complete removal of large colorectal polyps.


METHODS
Endoscopic polypectomy of 186 colorectal polyps larger than 3 cm in diameter (range, 3-13 cm) was performed; 141 were sessile and 45 pedunculated. Most of the polyps were located in the rectum (n = 88), sigmoid (n = 63), and cecum (n = 9). The remaining adenomas were situated in other parts of the colon. Sessile polyps were removed using the piecemeal technique.


RESULTS
Histology results showed an adenoma in 167 cases, and invasive carcinoma was present in the adenoma in 19 patients. Of the adenomas, 29 were tubulous, 118 tubulovillous, and 20 villous; adenoma with severe dysplasia was found in 49 cases. Complete endoscopic removal was achieved in all sessile and pedunculated polyps. None of the patients with invasive carcinoma who underwent surgical resection (n = 10) had any evidence of tumor in the resected specimen. Bleeding occurred in 4 patients after polypectomy (2 percent). Perforation occurred in 1 patient (0.5 percent), who had an invasive carcinoma of the cecum. There was no procedure-related mortality. During a mean follow-up period of 40 (range, 3-87) months, 6 patients presented with recurrence of a benign adenoma (3 percent), which was treated endoscopically, and 1 patient presented with a recurrent invasive carcinoma, which was treated surgically.


CONCLUSIONS
Endoscopic polypectomy is a safe and effective method of treating large colorectal polyps.
Doniec
J Marek
JM
Department of General and Thoracic Surgery, University Hospital, Christian Albrechts University, Arnold-Heller-Strasse 7, 24105 Kiel, Germany.
Löhnert
Mathias S
MS
Schniewind
Bodo
B
Bokelmann
Frank
F
Kremer
Bernd
B
Grimm
Horst
H
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D018256:Adenomatous Polyps / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000706:statistics & numerical data*; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000473:pathology / Q000601:surgery*; D007420:Intestine, Large; D008297:Male; D009364:Neoplasm Recurrence, Local; D019106:Postoperative Hemorrhage; D019564:Unnecessary Procedures