Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Polish Journal of Surgery

The Journal of Foundation of the Polish Journal of Surgery

12 Issues per year


CiteScore 2016: 0.29

SCImago Journal Rank (SJR) 2016: 0.166
Source Normalized Impact per Paper (SNIP) 2016: 0.207

Open Access
Online
ISSN
0032-373X
See all formats and pricing
More options …
Volume 83, Issue 10 (Oct 2011)

Issues

Large Colorectal Polyps - Endoscopic Polypectomy as an Alternative to Surgery

Michał Spychalski / Jarosław Buczyński / Jarosław Cywiński / Łukasz Dziki / Ewa Langner / Andrzej Sygut / Radzisław Trzciński / Adam Dziki
Published Online: 2011-12-21 | DOI: https://doi.org/10.2478/v10035-011-0084-7

Large Colorectal Polyps - Endoscopic Polypectomy as an Alternative to Surgery

Endoscopic polypectomy of colorectal polyps is a common procedure. However, endoscopic treatment of large polyps (those with a diameter exceeding 2 cm) remains questionable. There is a serious risk of colorectal carcinoma presence inside these lesions, which eventually would require surgical intervention. Apart from this fact endoscopic polypectomy of large polyps is connected with substantial risk of complications, such as perforation and bleeding. Many patients with large colorectal polyps are qualified for surgical intervention.

The aim of the study was to determine the efficacy and safety of polypectomy of large colorectal polyps.

Material and methods. The study presented results of endoscopic treatment in case of patients with large colorectal polyps at the Department of General and Colorectal Surgery, Medical University in Łódź. Patients were admitted to the hospital during the period between January, 2008 and January, 2010. The following parameters were analysed: location of polyps, percentage of high grade dysplasia, complete excision rate, and complications connected with polypectomy procedures.

Results. During the analyzed period of time 488 endoscopic polypectomies were performed. Forty-three large colorectal polyps were removed (8.8%). Seven (16.3%) of them were classified as flat polyps. Out of 488 removed polyps, 39 were classified as adenomas with high grade dysplasia (7.9%), while 16 were large-exceeding 2 cm (37.2%). Considering the group of large polyps no invasive carcinoma case was detected. The radical excision rate for large pedunculated polyps was obtained in 88.8% (32/36) of cases. In case of flat adenomas the above-mentioned parameter was lower - 57.1% (4/7). During polypectomy of large colorectal polyps one perforation was observed during the excision of a flat cecal polyp. In two cases immediate bleeding occurred (2/43). In both cases endoscopic treatment of bleeding proved sufficient.

Conclusions. Endoscopic polypectomy of large pedunculated polyps is a safe and efficient method, which makes it a rationale alternative for surgery. Polypectomy of flat adenomas is connected with a lower radical excision rate and higher risk of perforation.

Keywords: colorectal polyps; endoscopic polypectomy; flat adenomas; surgery

  • Shepherd NA: Polyps and polyposis syndromes of the intestines. Current Diagnostic Pathology 1997; 4: 222-38.Google Scholar

  • Huber AR, Shikle JF: Benign fibroblastic polyps of the colon. Arch Pathol Lab Med 2009; 133(11): 1872-76.Google Scholar

  • Chung YF, Ho YH, Nyam DC et al.: Management of colonic lipomas. Aust N Z J Surg 1998; 68: 133-35.PubMedGoogle Scholar

  • Binmoeller KF, Bohnacker S, Seifert H et al.: Endoscopic snare excision of "giant" colorectal polyps. Gastrointest Endosc 1996; 43: 183-88.PubMedGoogle Scholar

  • Onken, JE, Friedman, J, Subramanian S: Treatment patterns and costs associated with sessile colorectal polyps. Am J Gastroenterol 2002; 97(11): 2896-901.CrossrefGoogle Scholar

  • Bernard D, Ledit A, Towa O: Treatment of Large Colorectal Polyps: Endoscopic Versus Surgical Resection. Gastrointest Endosc 2004; 59(5): 286.CrossrefGoogle Scholar

  • Rex DK, Petrini JL, Baron TH: Quality indicators for colonoscopy. Am J Gastroenterol 2006; 101(4): 873-85.Google Scholar

  • Gregory G, Ginsberg MD: Risks of Colonoscopy and Polypectomy. Tech Gastrointest Endosc 2008; 10: 7-13.Google Scholar

  • Sorbi D, Norton I, Conio M et al.: Postpolypectomy lower GI bleeding: descriptive analysis. Gastrointest Endosc 2000; 51: 690-96.Google Scholar

  • Ahmad N, Kochman ML, Long WL et al.: Efficacy, safety, and clinicaloutcomes of endoscopic mucosal resection: a study of 101 cases. Gastrointest Endosc 2002; 55: 390-96.Google Scholar

  • Akahoshi K, Yoshimaga S, Fujimaru T et al.: Endoscopic resection with hypertonic saline-solution-epinephrine injection plus band ligation for large pedunculated or semipedunculated gastric polyp. Gastrointest Endosc 2006; 63: 312-16.PubMedGoogle Scholar

  • Hsieh YH, Lin HJ, Tseng GY et al.: Is submucosal epinephrine injection necessary before polypectomy? A prospective, comparative study. Hepatogastroenterology 2001; 48: 1379-82.PubMedGoogle Scholar

  • Reed B, Hogan B: Epinephrine volume reduction of giant colon polyps facilitates endoscopic assessment and removal. Gastrointestinal Endoscopy 2007; 66(5): 1018-22.Google Scholar

  • Iqbal CW, Chun YS, Farley DR: Colonoscopic perforations: a retrospective review. J Gastrointest Surg 2005; 9(9): 1229-35.PubMedCrossrefGoogle Scholar

  • Lüning TH, Keemers-Gels ME, Barendregt WB et al.: Colonoscopic perforations: a review of 30,366 patients. Surg Endosc 2007; 21(6): 994-97.Google Scholar

  • Lohsiriwat V, Sujarittanakarn S, Akaraviputh et al.: What are the risk factors of colonoscopic perforation? BMC Gastroenterol. 2009 Sep; 24; 9: 71.Web of ScienceCrossrefGoogle Scholar

About the article


Published Online: 2011-12-21

Published in Print: 2011-10-01


Citation Information: Polish Journal of Surgery, ISSN (Print) 0032-373X, DOI: https://doi.org/10.2478/v10035-011-0084-7.

Export Citation

This content is open access.

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

[1]
Zhi-Heng Huang, Zai Song, Ping Zhang, Jie Wu, and Ying Huang
World Journal of Gastroenterology, 2016, Volume 22, Number 11, Page 3261
[2]
C Hassan, A Repici, P Sharma, L Correale, A Zullo, M Bretthauer, C Senore, C Spada, Cristina Bellisario, P Bhandari, and D K Rex
Gut, 2016, Volume 65, Number 5, Page 806

Comments (0)

Please log in or register to comment.
Log in