Endoscopic management of nonlifting colon polyps

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Cancer Prevention

Background:

• The nonlifting polyp sign typically indicates invasive colon cancer.
• Prior endoscopic or surgical interventions can cause adenomas to become nonlifting due to fibrosis.
• The efficacy of endoscopic treatment for nonlifting adenomas is not well-established.

Purpose of the Study:

• To evaluate the outcomes of endoscopic resection for nonlifting adenomas with a history of prior interventions.
• To assess the safety and success rates of a standardized endoscopic resection protocol.

Main Methods:

• Retrospective review of 26 patients with nonlifting lesions from prior interventions.
• Exclusion of lesions with biopsy-proven invasive cancer.
• Standardized protocol: saline injection for lesions ≥ 8 mm, piecemeal snare polypectomy, and argon plasma coagulation (APC) if needed.

Main Results:

• Successful endoscopic resection in 25 of 26 patients (96%).
• 22 patients required both snare resection and APC.
• Recurrence rate was 26%, with all recurrences successfully retreated endoscopically.
• Low complication rate: 1 postprocedure bleed (4%), no perforations.

Conclusions:

• Most nonlifting adenomas resulting from prior interventions can be safely and effectively treated endoscopically.
• A combination of piecemeal polypectomy and ablation is a viable treatment strategy.
• High recurrence rates necessitate close follow-up and repeat endoscopic treatment when necessary.