Endoscopic mucosal resection of large colorectal polyps: prospective evaluation of recurrence and complications

Endoscopic mucosal resection (EMR) is a major therapeutic advance in the treatment of sessile and flat colorectal polyps. The aim of the study was to prospectively evaluate the success, complications and recurrence with EMR in colon.

From Jun/2008 to Jan/2012, patients referred for EMR of polyps > or =20 mm were included. Inject and cut EMR technique was used. Rates of complications and recurrence were assessed at 3, 12 and 36 months.

From 78 referred polyps, 73 EMR were performed in 71 patients (54% men, 65.8 +/- 10.6 years). Median polyp size was 30 (20; 35) mm, 64.4% sessile and 37% in rectum. Piecemeal removal performed in 863%. Median follow-up time was 12 (7; 15) months. Histological analysis revealed low-grade dysplasia in 51%, high-grade dysplasia in 37%, intramucosal carcinoma in 11% and invasive carcinoma in 1%. The case of invasive carcinoma was referred for surgery. There were 6 complications (8.2%) resolved without surgery : 5.5% of delayed bleeding, 1.4% of post-polypectomy syndrome and 1.4% of perforation. Recurrence was observed in 22.2% at 3 months, 11.1% at 12 months and 0% at 36 months. By logistic regression, a location near the pectinate line (OR 26.13) and a previous history of polypectomy (OR 7.70) became independent factors related to recurrence.

In our experience, EMR was a relatively safe procedure with all complications managed conservatively. We had an acceptable percentage of local recurrence and all cases of recurrence were treated endoscopically.