title: Work and resources needed for endoscopic resection of large sessile colorectal polyps.
abstract: OBJECTIVE
  Large sessile colon polyps often are referred for surgical resection, even when amenable to endoscopic resection. The aim of this study was to describe the resource use of endoscopic resection of large sessile colon polyps compared with small polyps with respect to physician time and equipment use.
  
  
  METHODS
  Retrospectively, procedure time, medication use, and equipment use were recorded for 184 consecutive patients with sessile colorectal polyps 2 cm or larger in size and for 184 consecutive control patients with only sessile polyps less than 2 cm in size or pedunculated polyps.
  
  
  RESULTS
  The mean duration of colonoscopy in patients with large sessile colon polyps averaged 51.4 (SD, 25.6) minutes compared with 20.0 (SD, 8.6) minutes for the control group (P < .0001). The large-polyp group required much more equipment to complete the polypectomy (eg, injection catheters and cautery probes) (P < .0001).
  
  
  CONCLUSIONS
  Our results indicate that the costs of endoscopic large sessile adenoma resection in physician work and equipment are substantially greater than the costs of resection of small adenomas. These costs may be a deterrent to endoscopic resection of large sessile adenomas and may warrant increased reimbursement for those procedures, particularly if predictions that colonoscopic procedures will become more complex in the future are realized.
authors.affiliation: Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Overhiser
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Rex
mesh_terms: D000368:Aged; D003111:Colonic Polyps / Q000191:economics / Q000473:pathology / Q000601:surgery*; D020685:Colonoscopes / Q000191:economics / Q000706:statistics & numerical data*; D003113:Colonoscopy / Q000191:economics / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000191:economics*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016526:Workload / Q000191:economics*