Endoscopy 2018; 50(04): S79
DOI: 10.1055/s-0038-1637262
ESGE Days 2018 oral presentations
21.04.2018 – Colon: endoscopic resection session 2
Georg Thieme Verlag KG Stuttgart · New York

COMPLETE ENDOSCOPIC MUCOSAL RESECTION OF MALIGNANT COLONIC SESSILE POLYPS AND CLINICAL OUTCOME OF 51 CASES

M Fragaki
1   Venizelion General Hospital, Department of Gastroenterology, Heraklion, Greece
,
E Voudoukis
1   Venizelion General Hospital, Department of Gastroenterology, Heraklion, Greece
,
E Chliara
2   Venizelion General Hospital, Department of Histopathology, Heraklion, Greece
,
I Dimas
1   Venizelion General Hospital, Department of Gastroenterology, Heraklion, Greece
,
A Mpitouli
1   Venizelion General Hospital, Department of Gastroenterology, Heraklion, Greece
,
E Vardas
1   Venizelion General Hospital, Department of Gastroenterology, Heraklion, Greece
,
A Theodoropoulou
1   Venizelion General Hospital, Department of Gastroenterology, Heraklion, Greece
,
K Karmiris
1   Venizelion General Hospital, Department of Gastroenterology, Heraklion, Greece
,
L Giannikaki
2   Venizelion General Hospital, Department of Histopathology, Heraklion, Greece
,
G Paspatis
1   Venizelion General Hospital, Department of Gastroenterology, Heraklion, Greece
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Meta-analyses and guidelines recommend that deep submucosal invasion (> 1 mm) in malignant colonic polyps is an important risk factor for residual malignant disease. However, the existing data are based on small retrospective studies with marked heterogeneity. The aim of this study is to test the correlation between the submucosal invasion depth and the rate of residual malignant disease in complete endoscopic mucosal resection (EMR) of malignant colonic sessile polyps. The secondary outcomes include risk factors such as: lymphovascular invasion, tumor differentiation, resection margin status and the presence of tumor budding.

Methods:

A retrospective review of the endoscopy charts for the period 2000 – 2016 was conducted. All patients enrolled exhibited a malignant colonic sessile polyp which was endoscopically completely resected. Histological findings of the polyps were also recorded. Thorough computed or magnetic scanning was performed in all patients before deciding on further management. All patients were advised for the option of surgical treatment or endoscopic follow-up.

Results:

51 patients with confirmed adenocarcinoma in sessile colonic polyps undergoing EMR were retrospectively included in this study. A total of 32 (62.7%) patients underwent subsequent surgery after EMR, and 19 (37.3%) chose endoscopic follow up. In 44 (86.3%) patients the submucosal invasion was > 1 mm. Residual malignant disease was identified in the surgical pathological specimen of only one patient. With a median follow-up of 23.41 months (IQR: 33.45; range 1.84 – 144.92), no local recurrences or lymph node metastasis were identified. 49 were alive without evidence of disease and 2 died of other causes (without evidence of disease at last follow-up).

Conclusions:

Our data suggest that even in cases with submucosal invasion > 1 m and the presence of other high-risk features (lymphovascular invasion, tumour budding), complete EMR in malignant colonic sessile polyps supported by the histological findings predicts for a good clinical outcome.