title: Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess the efficacy and safety of endoscopic resection of large colorectal polyps.
  
  
  METHODS
  Relevant publications were identified in MEDLINE/EMBASE/Cochrane Central Register for the period 1966-2014. Studies in which ≥20 mm colorectal neoplastic lesions were treated with endoscopic resection were included. Rates of postendoscopic resection surgery due to non-curative resection or adverse events, as well as the rates of complete endoscopic removal, invasive cancer, adverse events, recurrence and mortality, were extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random effect models. I2 statistic was used to describe the variation across studies due to heterogeneity. Meta-regression analysis was also performed.
  
  
  RESULTS
  50 studies including 6442 patients and 6779 large polyps were included in the analyses. Overall, 503 out of 6442 patients (pooled rate: 8%, 95% CI 7% to 10%, I2=78.6%) underwent surgery due to non-curative endoscopic resection, and 31/6442 (pooled rate: 1%, 95% CI 0.7% to 1.4%, I2=0%) to adverse events. Invasive cancer at histology, non-curative endoscopic resection, synchronous lesions and recurrence accounted for 58%, 28%, 2.2% and 5.9% of all the surgeries, respectively. Endoscopic perforation occurred in 96/6595 (1.5%, 95% CI 1.2% to 1.7%) polyps, while bleeding in 423/6474 (6.5%, 95% CI 5.9% to 7.1%). Overall, 5334 patients entered in surveillance, 502/5836 (8.6%, 95% CI 7.9% to 9.3%) being lost at follow-up. Endoscopic recurrence was detected in 735/5334 patients (13.8%, 95% CI 12.9% to 14.7%), being an invasive cancer in 14/5334 (0.3%, 95% CI 0.1% to 0.4%). Endoscopic treatment was successful in 664/735 cases (90.3%, 95% CI 88.2% to 92.5%). Mortality related with management of large polyps was reported in 5/6278 cases (0.08%, 95% CI 0.01% to 0.15%).
  
  
  CONCLUSIONS
  Endoscopic resection of large polyps appeared to be an extremely effective and safe intervention. However, an adequate endoscopic surveillance is necessary for its long-term efficacy.
authors: Endoscopy Unit, 'Nuovo Regina Margherita Hospital', Rome, Italy.
authors: C
authors: C
authors: Hassan
authors: Digestive Endoscopy Unit, Istituto Clinico Humanitas, Milan, Italy.
authors: A
authors: A
authors: Repici
authors: Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Kansas, USA.
authors: P
authors: P
authors: Sharma
authors: im3D S.p.A., Turin, Italy.
authors: L
authors: L
authors: Correale
authors: Endoscopy Unit, 'Nuovo Regina Margherita Hospital', Rome, Italy.
authors: A
authors: A
authors: Zullo
authors: Department of Health Economy and Health Management, University of Oslo, Oslo, Norway Gastroenterology Unit, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
authors: M
authors: M
authors: Bretthauer
authors: AOU S Giovanni Battista-CPO Piemonte, SCDO Epidemiologia dei Tumori 2, Turin, Italy.
authors: C
authors: C
authors: Senore
authors: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors: C
authors: C
authors: Spada
authors: Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK.
authors: Cristina
authors: C
authors: Bellisario
authors: Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors: P
authors: P
authors: Bhandari
authors: Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors: D K
authors: DK
authors: Rex
mesh_terms: D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects; D006801:Humans; D007417:Intestinal Polyps / Q000473:pathology / Q000601:surgery; D012002:Rectal Diseases / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: ENDOSCOPIC POLYPECTOMY