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SAFETY AND EFFECTIVENESS OF ENDOSCOPIC RESECTION OF LARGE, SESSILE COLONIC POLYPS
G Chan, N Khanna, J Gregor
University of Western Ontario, London, Ontario
Aims: The best approach to the management of large sessile colonic polyps encountered during colonoscopy remains controversial. The options include attempting endoscopic removal at the time, versus biopsy with subsequent attempt at endoscopic removal or surgical resection. Previous studies included polyps of various sizes, including smaller (2 to 3cm) polyps. We report on a case series of polypectomy of sessile polyps (more than 3 cm in size) to examine the safety and effectiveness of endoscopic resection.
Methods: We performed a retrospective review of cases of large sessile colonic polyps resection performed between 2005 and 2008 in our center. The characteristics of the polyps, rates of treatment success and complications were recorded.
Results: A total of 39 cases were identified. Average polyp size was 3.5 cm. Complications occurred in 6 cases (15%), with 3 cases (7.6%) of bleeding and two of them requiring transfusion. Two patients experienced post-polypectomy pain. There were no cases of perforation and no emergent surgery was required. Of the pathology identified, high grade dysplasia was found in 14 cases (35%). Cancer was identified in 5 cases (12.8%) and surgical treatment was pursued in 3 cases. The remaining two did not go for surgery because of significant co-morbidities and satisfactory endoscopic resection. Three non-cancerous cases (7.6%) were referred for surgery because of incomplete resection. The average number of repeat colonoscopy within 2 years to document complete resection was 1.5. Cure was achieved in 33 patients (85%) that were managed endoscopically.
Conclusions: Endoscopic resection of large, sessile colonic polyps is safe and effective with experience. Further examination of the data with cost-effectiveness analysis will help to determine the best approach.