title: Laparo-endoscopic resection for extensive and inaccessible colorectal polyps: a feasible and safe procedure.
abstract: BACKGROUND
  Polypectomy at colonoscopy may be difficult or dangerous. In such instances colonic resection may be indicated. Novel combined laparoscopic-endoscopic procedures have the potential to allow safe extensive extramucosal resection, thus avoiding resection. Laparoscopic colon mobilisation provides a more favourable orientation for endoscopic mucosal resection and facilitates identification of possible perforation sites with immediate laparoscopic repair or resection if necessary. This study aimed to assess the efficacy and safety of laparo-endoscopic resection (LER) of colonic polyps.
  
  
  METHODS
  Data were collected prospectively on consecutive patients undergoing LER. The mode of presentation, referral pattern, lesion site and size, hospital stay, procedural details, complications, histology and further treatment were recorded.
  
  
  RESULTS
  A total of 13 patients underwent attempted LER (16 polyps in total) and this was completed for 10, with a median hospital stay of 2 days. Five polyps were removed whole and eight piecemeal. Excision was clinically complete in all cases. Three procedures were converted to colonic resection. One lesion appeared malignant, indicating a conversion to laparoscopic right hemicolectomy. Two polyps were not amenable to LER and resection was performed. One patient underwent subsequent colonic resection based on the histological findings. There were no perforations or serious complications.
  
  
  CONCLUSIONS
  LER is a safe and effective treatment for large and inaccessible colonic polyps that would otherwise be treated by colonic resection.
authors.affiliation: Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, UK. jimwood@doctors.net.uk
authors.forename: J J
authors.initials: JJ
authors.lastname: Wood
authors.forename: A C
authors.initials: AC
authors.lastname: Lord
authors.forename: J M D
authors.initials: JM
authors.lastname: Wheeler
authors.forename: N R
authors.initials: NR
authors.lastname: Borley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome