Endoscopic piecemeal resection of large colorectal polyps with long-term followup.
BACKGROUND
Colonoscopic removal of large colorectal polyps is challenging and requires advanced endoscopic technique. Successful endoscopic management not only avoids the morbidity of surgery but also risks perforation, hemorrhage, and recurrence.


METHODS
This study is a retrospective review of a prospectively maintained database of all patients undergoing cautery snare piecemeal polypectomy for large colorectal polyps by a single operator over 20 years with long-term followup.


RESULTS
231 patients underwent 269 piecemeal polypectomies over a 20 year period. The complication rate was 4.3 %. Malignancy was identified in 25 (10.8 %) of patients. Local recurrences occurred in 24 % of patients with benign adenomas. The vast majority of these were managed with repeat endoscopy. Overall, benign large polyps were managed successfully endoscopically in 94.4 % of patients.


CONCLUSIONS
Piecemeal polypectomy is effective and safe for the management of large colorectal polyps. With long-term followup, the recurrence rate is appreciable, but most recurrences can be successfully managed with further endoscopic intervention. More complex techniques such as endoscopic submucosal dissection are usually unnecessary.
Department of Surgery, Massachusetts General Hospital, Boston, MA, USA, LHMaguire@partners.org.
Lillias H
LH
Maguire
Paul C
PC
Shellito
D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D004210:Dissection; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies