title: Efficacy, safety and outcomes of 'inject and cut' endoscopic mucosal resection for large sessile and flat colorectal polyps.
abstract: OBJECTIVE
  The study examines the outcomes of the 'inject and cut' endoscopic mucosal resection (EMR), for large sessile and flat colorectal polyps.
  
  
  METHODS
  Between January 2006 and December 2008 all patients referred to our institution for EMR of large polyps were prospectively evaluated. The accuracy of lifting sign and the rate of en bloc and piecemeal resection, complications and recurrence were analyzed.
  
  
  RESULTS
  A total of 157 patients with 182 lesions (median size 24.7 +/- 10.2 mm) were included in the study. The most frequent location was the sigmoid colon in 30.2%. Because of non-lifting sign, 5/182 lesions were referred to surgical resection and 177 (43 flat and 134 sessile) were resected, 79 (44.6%) en bloc and 98 (55.4%) piecemeal. There were 20 procedural (11.3%) and 2 late (1.1%) bleeding, 4 post-polypectomy syndrome (2.2%) and 2 perforations (1.1%). Bleeding was related to malignancy (p = 0.01). Intramucosal cancer was observed in 5 cases (2.8%) while invasive cancer was seen in 8 (4.5%). Malignancy was related to polyp size >or=30 mm (p = 0.002). Follow-up colonoscopy was performed in 147 patients with 172 EMR for a mean of 19.8 months. Recurrence was observed in 12/172 (6.9%) polyps.
  
  
  CONCLUSIONS
  Inject and cut EMR is practical and effective with a low risk of complication and local recurrence.
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy. f.ferrara@ausl.bologna.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Ferrara
authors.forename: Carmelo
authors.initials: C
authors.lastname: Luigiano
authors.forename: Stefania
authors.initials: S
authors.lastname: Ghersi
authors.forename: Carlo
authors.initials: C
authors.lastname: Fabbri
authors.forename: Marco
authors.initials: M
authors.lastname: Bassi
authors.forename: Patrizia
authors.initials: P
authors.lastname: Landi
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Polifemo
authors.forename: Paola
authors.initials: P
authors.lastname: Billi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cennamo
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Consolo
authors.forename: Angela
authors.initials: A
authors.lastname: Alibrandi
authors.forename: Nicola
authors.initials: N
authors.lastname: D'Imperio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy; D004598:Electrosurgery; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012008:Recurrence; D018709:Statistics, Nonparametric; D016896:Treatment Outcome