Endoscopic submucosal dissection of large pedunculated polyps with wide stalks: a retrospective multicenter study
Background Endoscopic resection of large pedunculated colorectal polyps is technically difficult, especially when the polyp is large and has such a thick stalk that it is either too difficult or impossible to resect prophylactically by a conventional snare. Here, we evaluated the feasibility of ESD for large pedunculated polyps with wide stalks.
Methods 29 patients with large pedunculated polyps that were not resectable by polypectomy or endoscopic mucosal resection were enrolled in the study.
Results En bloc resection was achieved in 28/29 polyps. One suspended case was due to severe fibrosis with muscle retraction signs. The mean diameter of the 29 polyp heads was 39.7 (standard deviation 6.9) mm. Submucosal fibrosis was present in 16 polyps (9 mild; 7 severe). The stalks of severely fibrotic polyps were significantly thicker than those of polyps with no or mild fibrosis. The curative resection rate was 85.7 % without severe complications.
Conclusions ESD is feasible for the removal of large pedunculated polyps with wide stalks when conventional snare resection is difficult or impossible.
Eingereicht: 02. Februar 2020
Angenommen: 15. Mai 2020
09. Juli 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Dobrowolski S, Dobosz M, Babicki A. et al. Blood supply of colorectal polyps correlates with risk of bleeding after colonoscopic polypectomy. Gastrointest Endosc 2006; 63: 1004-1009
- 2 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297
- 3 Matsuda T, Fukuzawa M, Uraoka T. et al. Risk of lymph node metastasis in patients with pedunculated type early invasive colorectal cancer: a retrospective multicenter study. Cancer Sci 2011; 102: 1693-1697
- 4 Haggitt RC, Glotzbach RE, Soffer EE. et al. Prognostic factors in colorectal carcinomas arising in adenomas: implications for polyps removed by endoscopic polypectomy. Gastroenterology 1985; 89: 328-336
- 5 Tanaka S, Kashida H, Saito Y. et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2019; 32: 219-239
- 6 Chiba H, Tachikawa J, Arimoto J. et al. Predictive factors of mild and severe fibrosis in colorectal endoscopic submucosal dissection. Dig Dis Sci 2020; 65: 232-242
- 7 Sugiyama S, Nagasako K, Kawanami C. et al. A study on the morphological change of pedunculated submucosal invasive colon cancer (in Japanese). Gastroenterol Endosc 1993; 35: 1588-1592
- 8 Hashiguchi Y, Muro K, Saito Y. et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 2020; 25: 1-42
- 9 Matsumoto A, Tanaka S, Oba S. et al. Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis. Scand J Gastroenterol 2010; 45: 1329-1337
- 10 Toyonaga T, Tanaka S, Man-I M. et al. Clinical significance of the muscle-retracting sign during colorectal endoscopic submucosal dissection. Endosc Int Open 2015; 3: E246-251
- 11 Di Giorgio P, De Luca L, Calcagno G. et al. Detachable snare versus epinephrine injection in the prevention of postpolypectomy bleeding: a randomized and controlled study. Endoscopy 2004; 36: 860-863
- 12 Kurzon RM, Ortega R, Rywlin AM. The significance of papillary features in polyps of the large intestine. Am J Clin Pathol 1974; 62: 447-454
- 13 Yang CW, Yen HH, Chen YY. et al. Use of dual knife for large pedunculated colorectal polyps. Surg Laparosc Endosc Percutan Tech 2014; 24: 444-447
- 14 Choi YS, Lee JB, Lee EJ. et al. Can endoscopic submucosal dissection technique be an alternative treatment option for a difficult giant (≥30 mm) pedunculated colorectal polyp?. Dis Colon Rectum 2013; 56: 660-666
- 15 Ma L, Zhai Y, Chai N. et al. Insulated-tip knife endoscopic polypectomy for difficult pedunculated colorectal polyps: a prospective pilot study. Int J Colorectal Dis 2017; 32: 287-290