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Avoiding surgery in patients with colorectal polyps.

James M Church1

  • 1Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.

Diseases of the Colon and Rectum
|November 8, 2003
PubMed
Summary
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Most colorectal polyps referred for surgery can be successfully managed with endoscopic polypectomy. A second opinion before surgery is recommended for difficult or potentially dangerous polyps.

Area of Science:

  • Gastroenterology
  • Surgical Oncology

Background:

  • Colorectal polyps can be challenging to remove endoscopically, often leading to surgical referral.
  • Surgical resection carries inherent risks and costs.

Purpose of the Study:

  • To evaluate the feasibility of endoscopic management for colorectal polyps referred for surgical resection.
  • To determine the success rate of endoscopic polypectomy in this patient group.

Main Methods:

  • Prospective data collection from an endoscopic database.
  • Identification of patients referred for surgical resection of colorectal polyps (excluding rectal).
  • Pre-surgical colonoscopy to assess endoscopic manageability and treatment outcomes.

Main Results:

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  • 58 patients were referred for surgery; 43/58 (74%) ultimately avoided surgery after successful endoscopic management.
  • Initial endoscopic polypectomy success rate was 48/58.
  • Complications included post-polypectomy bleeds and post-polypectomy syndrome; surgical complications were splenic injury and ventral hernia.
  • Malignancy or severe dysplasia was present in 26 polyps, with some requiring subsequent surgery.

    • Conclusions:

    • Endoscopic management is a viable and successful option for the majority of colorectal polyps referred for surgery.
    • A second opinion for endoscopic evaluation is crucial before proceeding with surgical resection for difficult or high-risk polyps.