OUTCOMES OF ENDOSCOPIC MUCOSAL RESECTION OF LARGE NON-PEDUNCULATED COLORECTAL POLYPS – A PROSPECTIVE STUDY FROM A PORTUGUESE REFERRAL CENTER

Aims:

Endoscopic mucosal resection (EMR) has been shown to be useful in the removal of large non-pedunculated colorectal polyps (LNPCP), avoiding the need for surgical resection. We aimed to prospectively evaluate the success, complications and recurrence with EMR in the management of LNPCP.

Methods:

From April/2013 to April/2017 patients referred for EMR of LNPCp ≥15 mm were included in the study. Inject and cut EMR technique was used. The endoscopic and histologic characteristics, complications, and surgical need were periodically recorded. Recurrence rates were assessed until October/2017.

Results:

During the study we performed 150 EMRs in 147 patients (55% men; mean age 68.8 ± 9.6 years). Lesions mean size was 23 (15; 50)mm. The majority of lesions were located in the cecum and ascendant colon (49.8%). En-bloc resection was performed in 56.6% of cases. Histological analysis revealed hyperplastic polyp in 5.3%, adenoma in 86.7% and adenocarcinoma in 8%. The total complication rate was 9,3% (6 intra-procedural bleeding; 6 delayed bleeding; 2 perforation). The two perforations were successfully surgically treated. Local recurrence occurred in 25/150 (16.6%), 23 of whom were managed with a new EMR. Thirteen patients (8,6%) were referred for surgery, because of adenocarcinoma without criteria of endoscopic cure or impossibility of complete endoscopical resection of the index lesion. The recurrence rate was associated with piece-meal ressection (p = 0.011). However, it was not affected by the lesion's dimension or location.

Conclusions:

In our experience, EMR was a relatively safe procedure. It was effective in the treatment of colorectal LNPCP. EMR is feasible for managing most local recurrences.