title: Endoscopic excision of large colorectal polyps as a viable alternative to surgical resection.
abstract: OBJECTIVE
  To determine the outcome of endoscopic excision of large colorectal polyps.
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  Kaiser Permanente, a large health care maintenance organization.
  
  
  METHODS
  One hundred four consecutive patients with large colorectal lesions deemed not amenable to endoscopic resection at initial colonoscopy and referred for surgical resection.
  
  
  METHODS
  Endoscopic excision under intravenous sedation by 2 interventional endoscopists.
  
  
  METHODS
  Endoscopic success (the ability to completely eradicate the original or recurrent lesion endoscopically at the index procedure or at reintervention), procedure-related complications, disease recurrence, endoscopic reintervention, and surgical intervention.
  
  
  RESULTS
  We included 48 men (46%) and 56 women (54%) with a mean age of 67 (range, 29-92) years for analysis. Anatomic distribution of the lesions included the colon (68%) and rectum (32%). Thirty-nine patients (37%) had carcinoma. The median size of the lesions was 3.0 (range, 1-9) cm. The endoscopic success rate was 83% and was highest in patients with noncarcinoma histologic findings compared with carcinoma (P < .001). The morbidity rate was 7%, and all complications occurred in the ascending colon (P = .06). Endoscopic reintervention occurred in 25 of 92 patients (27%). Surgical intervention was undertaken in 14% of all patients. During a mean follow-up of 14 (median, 12) months, recurrent disease was noted in 10 of 86 patients (12%) and occurred more frequently in rectal lesions (P = .002). All recurrences were eradicated endoscopically.
  
  
  CONCLUSIONS
  Endoscopic excision of large colorectal polyps is a viable alternative to surgical resection in a select group of patients and can be performed safely with a good success rate.
authors.affiliation: Department of Gastroenterology, Kaiser Permanente, Los Angeles, CA 90027, USA.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Kao
authors.forename: Andrew Q
authors.initials: AQ
authors.lastname: Giap
authors.forename: Maher A
authors.initials: MA
authors.lastname: Abbas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome