title: Endoscopic mucosal resection of 161 cases of large sessile or flat colorectal polyps.
abstract: OBJECTIVE
  Large sessile or flat colorectal polyps, which are traditionally treated surgically, may be amenable to endoscopic mucosal resection (EMR), often using a piecemeal method. Appropriate selection of lesions and a careful technique may enhance the efficacy of EMR for polyps >or=20 mm in diameter without compromising safety. The aim of this study was to identify the factors that may be predictive of the risk of polyp recurrence.
  
  
  METHODS
  A retrospective analysis was conducted on the outcome of 161 polyps >or=20 mm in diameter, treated by piecemeal EMR at a single centre using the "lift and cut" technique. All records were reviewed for polyp size, site, morphology and histology. Polypectomy technique, patient follow-up, polyp recurrence and surgical interventions were also recorded.
  
  
  RESULTS
  Over an 8-year period, 161 colonic polyps measuring >or=20 mm were removed by EMR. Follow-up data were available for 149 cases (93%) with a mean polyp diameter of 32.5 mm; the total success rate of endoscopic polyp removal was 95.4%. The number of cases requiring 1, 2, 3, 4 and 6 attempts at EMR was 89 (60%), 36 (24%), 14 (9%), 2 (1.3%) and 1 (0.7%), respectively. Recurrence was significantly related to polyp size (p<0.001). There was no statistically significant relationship between site and recurrence. Seven patients (4.6%) underwent surgical intervention after EMR because of failed clearance. There were no post-EMR perforations and significant bleeding was reported in only two patients (1.7%).
  
  
  CONCLUSIONS
  With careful attention to technique, piecemeal EMR is a safe option for the resection of most sessile and flat colorectal polyps >or=20 mm in size. A stricter follow-up may be required for larger lesions because of a higher risk of recurrence.
authors.affiliation: St Mark's Hospital, London, UK. naila.arebi@imperial.ac.uk
authors.forename: Naila
authors.initials: N
authors.lastname: Arebi
authors.forename: David
authors.initials: D
authors.lastname: Swain
authors.forename: Noriko
authors.initials: N
authors.lastname: Suzuki
authors.forename: Chris
authors.initials: C
authors.lastname: Fraser
authors.forename: Ashley
authors.initials: A
authors.lastname: Price
authors.forename: Brian P
authors.initials: BP
authors.lastname: Saunders
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome