Endoscopic management of large colorectal polyps

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Cancer Screening

Background:

• Optimal treatment for large colorectal polyps (LCPs) remains debated.
• Endoscopic polypectomy (EP) is a potential therapeutic option for LCPs.

Purpose of the Study:

• To evaluate the safety and effectiveness of endoscopic polypectomy (EP) for colorectal polyps greater than or equal to 2 cm.
• To assess complication and recurrence rates following EP of LCPs.

Main Methods:

• A retrospective analysis of 151 EP procedures performed over 7 years.
• Utilized diathermal snare for pedunculated/pseudopedunculated polyps and EMR/biopsy forceps for sessile/flat polyps.
• Histological analysis of resected polyps and scheduled follow-up for 12 months to record complications and recurrences.

Main Results:

• Most polyps (131/151) were adenomas; 5 invasive carcinomas required resection.
• Immediate bleeding occurred in 7.6% (n=10), perforations in 2.3% (n=3), and delayed bleeding in 1.5% (n=2).
• Incomplete excision or recurrence was observed in 4.6% (n=6) and 2.3% (n=3) respectively, all managed endoscopically.

Conclusions:

• Endoscopic polypectomy (EP) demonstrates relative safety and effectiveness for benign-appearing large colorectal polyps (LCPs).
• Low rates of significant complications and successful management of recurrences support EP as a primary treatment modality.