Large Sessile Serrated Polyps Can Be Safely and Effectively Removed by Endoscopic Mucosal Resection.
OBJECTIVE
As many as 50% of large sessile serrated adenomas/polyps (SSPs) are removed incompletely, which is significant because SSPs have been implicated in the development of interval cancers. It is unclear if endoscopic mucosal resection (EMR) is an optimal method for removal of SSPs. We assessed the efficacy and safety of removal of SSPs 10 mm and larger using a standardized inject-and-cut EMR technique.


METHODS
We performed a retrospective analysis of colonoscopy data, collected over 7 years (2007-2013) at 2 centers, from 199 patients with proximal colon SSPs 10 mm and larger (251 polyps) removed by EMR by 4 endoscopists. The primary outcome measure was local recurrence. The secondary outcome measure was safety.


RESULTS
At the index colonoscopy, patients had a median of 1 serrated lesion (range, 1-12) and 1 nonserrated neoplastic lesion (range, 0-15). The mean SSP size was 15.9 ± 5.3 mm; most were superficially elevated (84.5%) and located in the ascending colon (51%), and 3 SSPs (1.2%) had dysplasia. Surveillance colonoscopies were performed on 138 patients (69.3%) over a mean follow-up period of 25.5 ± 17.4 months. Of these patients, 5 had local recurrences (3.6%; 95% confidence interval, 0.5%-6.7%), detected after 17.8 ± 15.4 months, with a median size of 4 mm. No patients developed postprocedural bleeding, perforation, or advanced colon cancer, or had a death related to the index colorectal lesion during the study period.


CONCLUSIONS
Inject-and-cut EMR is a safe and effective technique for the resection of SSPs. Less than 5% of patients have a local recurrence, which is usually small and can be treated endoscopically.
Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Palo Alto, California.
Aarti K
AK
Rao
Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Palo Alto, California.
Roy
R
Soetikno
The University of Texas MD Anderson Cancer Center, Houston, Texas.
Gottumukkala S
GS
Raju
The University of Texas MD Anderson Cancer Center, Houston, Texas.
Phillip
P
Lum
Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Palo Alto, California.
Robert V
RV
Rouse
Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Palo Alto, California.
Tohru
T
Sato
Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Palo Alto, California.
Diane
D
Titzer-Schwarzl
Icahn School of Medicine at Mount Sinai, New York, New York.
James
J
Aisenberg
Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Palo Alto, California. Electronic address: endoresection@me.com.
Tonya
T
Kaltenbach
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
Early Detection; Endoscopy; Malignancy; Tumor