title: Large colorectal polyps--endoscopic polypectomy as an alternative to surgery.
abstract: Endoscopic polypectomy of colorectal polyps is a common procedure. However, endoscopic treatment of large polyps (those with a diameter exceeding 2 cm) remains questionable. There is a serious risk of colorectal carcinoma presence inside these lesions, which eventually would require surgical intervention. Apart from this fact endoscopic polypectomy of large polyps is connected with substantial risk of complications, such as perforation and bleeding. Many patients with large colorectal polyps are qualified for surgical intervention. THE AIM OF THE STUDY was to determine the efficacy and safety of polypectomy of large colorectal polyps.
  
  
  METHODS
  The study presented results of endoscopic treatment in case of patients with large colorectal polyps at the Department of General and Colorectal Surgery, Medical University in Łódź. Patients were admitted to the hospital during the period between January, 2008 and January, 2010. The following parameters were analysed: location of polyps, percentage of high grade dysplasia, complete excision rate, and complications connected with polypectomy procedures.
  
  
  RESULTS
  During the analyzed period of time 488 endoscopic polypectomies were performed. Forty-three large colorectal polyps were removed (8.8%). Seven (16.3%) of them were classified as flat polyps. Out of 488 removed polyps, 39 were classified as adenomas with high grade dysplasia (7.9%), while 16 were large-exceeding 2 cm (37.2%). Considering the group of large polyps no invasive carcinoma case was detected. The radical excision rate for large pedunculated polyps was obtained in 88.8% (32/36) of cases. In case of flat adenomas the above-mentioned parameter was lower--57.1% (4/7). During polypectomy of large colorectal polyps one perforation was observed during the excision of a flat cecal polyp. In two cases immediate bleeding occurred (2/43). In both cases endoscopic treatment of bleeding proved sufficient.
  
  
  CONCLUSIONS
  Endoscopic polypectomy of large pedunculated polyps is a safe and efficient method, which makes it a rationale alternative for surgery. Polypectomy of flat adenomas is connected with a lower radical excision rate and higher risk of perforation.
authors.affiliation: General and Colorectal Surgery Departament, Medical University in Łódź.
authors.forename: Michał
authors.initials: M
authors.lastname: Spychalski
authors.forename: Jarosław
authors.initials: J
authors.lastname: Buczyński
authors.forename: Jarosław
authors.initials: J
authors.lastname: Cywiński
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Dziki
authors.forename: Ewa
authors.initials: E
authors.lastname: Langner
authors.forename: Andrzej
authors.initials: A
authors.lastname: Sygut
authors.forename: Radzisław
authors.initials: R
authors.lastname: Trzciński
authors.forename: Adam
authors.initials: A
authors.lastname: Dziki
mesh_terms: D000328:Adult; D000368:Aged; D003111:Colonic Polyps / Q000175:diagnosis* / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007420:Intestine, Large / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011044:Poland; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D012002:Rectal Diseases / Q000175:diagnosis* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome