Endoscopic submucosal dissection of colorectal pedunculated polyps

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• Accurate histologic staging of pedunculated colon polyps requires en bloc resection, including the stalk.
• Conventional snare resection can be challenging for large polyps or those with broad stalks.
• Endoscopic submucosal dissection (ESD) is explored for its feasibility in these challenging cases.

Purpose of the Study:

• To evaluate the feasibility and efficacy of endoscopic submucosal dissection (ESD) for resecting large pedunculated colon polyps with broad stalks.
• To assess en bloc resection rates, R0 resection, and curative resection rates using ESD.
• To determine the accuracy of histologic staging and risk classification following ESD.

Main Methods:

• A prospective study included patients with large pedunculated polyps (diameter ≥ 20 mm or stalk > 5 mm) between February 2019 and November 2021.
• All polyps were resected using the ESD technique, involving dissection of the polyp stalk at its base after submucosal injection.
• Data collected included polyp characteristics, resection outcomes, histologic findings, and adverse events.

Main Results:

• Twenty-five patients underwent ESD for large pedunculated polyps, achieving 100% en bloc resection.
• The median polyp size was 30×25×17 mm, with most located in the sigmoid colon.
• Histologic examination revealed adenomas, high-grade intraepithelial neoplasia, and adenocarcinoma in 32% of cases. R0 resection rate was 100%, and the curative resection rate was 96% without severe adverse events.

Conclusions:

• Endoscopic submucosal dissection (ESD) is a feasible and effective method for achieving high en bloc and R0 resection rates in large pedunculated colon polyps.
• The high curative resection rate (96%) highlights ESD's role in accurate risk classification, especially given that a significant proportion (32%) of polyps harbored adenocarcinoma.
• ESD offers a safe and effective alternative to conventional methods for managing complex pedunculated polyps, improving diagnostic accuracy and patient outcomes.