Endoscopy 2020; 52(S 01): S113-S114
DOI: 10.1055/s-0040-1704349
ESGE Days 2020 oral presentations
Saturday, April 25, 2020 08:30 – 10:30 Large colonic polyps: Slice and dice The Liffey B
© Georg Thieme Verlag KG Stuttgart · New York

COLD PIECEMEAL ENDOSCOPIC MUCOSAL RESECTION (EMR) FOR LARGE ADENOMAS AND SERRATED POLYPS: A TERTIARY REFERRAL CENTRE EXPERIENCE

R Rameshshanker
1   St Mark’s Hospital, Wolfson Unit for Endoscopy and Academic Institute, London, UK
,
A Wawszczak
1   St Mark’s Hospital, Wolfson Unit for Endoscopy and Academic Institute, London, UK
,
B Saunders
1   St Mark’s Hospital, Wolfson Unit for Endoscopy and Academic Institute, London, UK
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims: Background Conventional EMR carries a risk of delayed bleeding, perforation and post polypectomy syndrome. Incomplete polyp resection could lead to recurrence and post colonoscopy cancer.

    Aims Utilisation of cold EMR in the endoscopic management of large sessile serrated polyps and adenomas.

    Methods Prospective databases from our institution including 113 consecutive patients with 149 polyps (>1cm in size) resected by cold EMR between 2016 and 2018 were included. Demographics, clinicopathological and polyp characteristics, surveillance and recurrence data were analysed.

    Results Male: female was 2:1 with a median age of 65 years (35-83). Median polyp size was 19mm (10-40mm). one hundred and seventeen polyps (78%) were in the proximal colon. Histology of resected polyps were: 47 adenomas (32%) and 102 sessile serrated polyps of which 3 had dysplasia (2.9%).

    Intra procedural oozing was witnessed during resection and settled without any haemostatic interventions in 98.6% of cases. 2 cases needed application of clips to achieve haemostasis. One patient was admitted following the procedure with abdominal pain and managed conservatively. There were no delayed bleeding or perforation. A surveillance colonoscopy (6-36 months) were carried out in 80 patients (71%) and the remainder of the patients either awaiting a planned surveillance or discharged from surveillance programme.

    Overall recurrence rate following cold EMR was 3.7% (4/108) and successfully treated with cold snare resection.

    Conclusions Cold EMR for large adenomas and serrated polyps appears to be safe and feasible without any immediate or delayed complications.


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