Endoscopic Resection of ”Giant” Colorectal Lesions: Long-Term Outcome and Safety[1]

Zusammenfassung

Hintergrund: Heutzutage stellt die endoskopische Resektion die Standardprozedur bei der Abtragung kolorektaler Polypen dar. Vor der Etablierung endoskopischer Techniken kam der Abtragung kolorektaler Polypen mit einer Größe von über 3 cm eine eindeutige Präferenz zu. Die Sicherheit und Effektivität der endoskopischen Abtragung von Polypen über 3 cm wurden in zahlreichen Studien belegt. Patienten und Methodik: Es wurden Daten von 165 Patienten (Alter 68 ± 10,4 Jahre) mit insgesamt 167 Polypen evaluiert. Die Polypen wiesen eine Mindestgröße von 3 cm auf. Im Blickpunkt des Interesses war die makroskopische und histologische Morphologie der Polypen, die Lokalisation im Kolon, die Modalitäten der Polypabtragung sowie das Follow-up. Patienten mit makroskopisch eindeutig malignitätsverdächtigen Polypen wurden ausgeschlossen. Ergebnisse: Erfolgreich endoskopische Abtragungen gelangen in 72,5 %. Dabei war in 73,6 % aller Resektionen die Anwendung der Piecemeal-Technik erforderlich. Rezidive traten nach kompletten Resektionen in 26,3 % (nach einem mittleren Follow-up von 16 ± 12,5 Monaten) auf. Es lag eine Komplikationsrate von 19,2 % vor. Relevante Blutungen und Perforationen wurden als frühe Komplikationen in 18,6 % registriert. Eine interventionsbedingte Mortalität wurde nicht festgestellt. Schlussfolgerung: Endoskopische Mukosaresektionen stellten eine sichere und effiziente Methode zur Abtragung großer kolorektaler Polypen dar. Kontrolluntersuchungen sollten in zeitlich definierten Abständen zur Detektion von Rezidivpolypen erfolgen.

Abstract

Background: Today, endoscopic resection is a standard procedere for the resection of colonic polyps. Before the establishment of endoscopic techniques, the surgical approach was a clearly preferred method for removal of polyps with a size larger than three centimeters. The safety and effectiveness concerning endoscopic resections of colorectal polyps also with a size of more than 3 cm have been demonstrated in numerous studies. Patients and Methods: Data from 165 patients (age: 68 ± 10.4 years) harboring 167 polyps with a minimum diameter of 3 cm were retrospectively evaluated. Objects of interest were macroscopic morphology and histopathology of the polyps, their localization in the colon, the modality of endoscopic resection and follow-up. In those cases with macroscopic signs of malignancy the patients were excluded. Results: Successful endoscopic resections were obtained in 72.5 %. Therefrom, resection in the piecemeal-technique was necessary in 73.6 %. Recurrence polyps after endoscopic complete resections occurred in 26.3 % after a mean follow-up of 16 ± 12.5 months. We registered a complication rate of 19.2 %. Relevant bleeding and perforation were registered as early complications in 18.6 %. We observed no intervention-related mortality. Conclusion: Endoscopic mucosal resection is a safe and efficient method even for removing giant colorectal polyps. Controls are recommended at defined intervals for detecting polyp recurrence.

Schlüsselwörter

Giant Polyps - kolorektales Adenom - endoskopische Resektion - rezidivierende Polypen

Key words

giant polyps - colorectal adenoma - endoscopic resection - recurring polyps

1 Rico Hochdörffer and Axel Eickhoff are both first authors, because both are involved in creation of the manuscript in equal parts.

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1 Rico Hochdörffer and Axel Eickhoff are both first authors, because both are involved in creation of the manuscript in equal parts.