Endoscopy 2024; 56(02): 125-130
DOI: 10.1055/a-2174-2967
Innovations and brief communications

Endoscopic resection of large anastomotic polyps is safe and effective

Oliver Cronin
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
Julia Gauci
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
Anthony Whitfield
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
Timothy O'Sullivan
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
Muhammad Abuarisha
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
Hunter Wang
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
Eric Yong Tat Lee
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
Stephen J Williams
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
,
Michael J. Bourke
1   Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia (Ringgold ID: RIN8539)
2   Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia (Ringgold ID: RIN216997)
› Author Affiliations
Supported by: Cancer Institute NSW


Abstract

Background Large (≥20mm) adenomatous anastomotic polyps (LAAPs) are uncommon. Data pertaining to their prevalence, characteristics, and the efficacy of endoscopic resection (ER) are absent. A safe and effective strategy for ER would reduce morbidity and healthcare costs.

Methods Large nonpedunculated colorectal polyps of ≥20mm (LNPCPs) referred for ER were prospectively studied. Multiple data points were recorded including anastomotic location, polyp morphology, resection modality, complications, and technical success.

Results Over 7 years until November 2022, 2629 lesions were referred. Of these, 10 (0.4%) were LAAPs (median size 35 mm [interquartile range (IQR) 30–40mm]). All LAAPs were removed by piecemeal endoscopic mucosal resection (EMR), most (n=9; 90%) in combination with cold-forceps avulsion with adjuvant snare-tip soft coagulation (CAST). On comparison of the LAAP group with the conventional LNPCP group, CAST was more commonly used (90% vs. 9%; P<0.001) and deep mural injury (DMI) type II was more frequent (40% vs. 11%, P=0.003); however, significant DMI (III–V) did not occur. At 6 month (IQR 5.25–6 months) surveillance, there was no recurrence in any of the 10 cases. There were no serious adverse events.

Conclusions LAAPs present unique challenges owing to their location overlying an anastomosis. Despite these challenges they can be safely and effectively managed endoscopically without recurrence at endoscopic follow-up.



Publication History

Received: 28 April 2023

Accepted after revision: 12 September 2023

Accepted Manuscript online:
12 September 2023

Article published online:
10 November 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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