ESD RESECTION OF COLRECTAL PEDUNCULATED POLYPS: FIRST RESULTS

Aims Endoscopic conventional resection of pedunculated polyps is technically difficult in cases of large polyp and/or broad stalk. In particular, en bloc resection with conventional snare resection can be challenging in these cases. We evaluated the feasibility of ESD for large pedunculated polyps with wide stalks.

Methods In the period between 02- 2019 and 11- 2021 patients with large pedunculated polyps assessed difficult or not conventionally resectable by snare polypectomy were enrolled in the study. All polyps were resected in ESD technique with dissection of the polyp stalk at the base after injection. Bleeding vessels were coagulated using the ESD knife or a coagulation forceps.

Results 21 patients (male=14, 65,8y mean) were included. En bloc and R0 resection was achieved in 100% (21/21) of polyps. Polyps were mainly located in the sigmoid (n=16), rectum (n=2) and one each in the ascending and descending colon. Mean size of polyps was 33.4 x 27.2 mm. Histologic examination revealed the following results: Adenoma LG-IN: 7; HG-IN 6, pTis: 2, Adenoarcinoma: 4 (G1,pT1m,L0,V0 – G2, pT1(SM1) L0,V0 – G1,pT1(SM1)L0,V0 – G3,pT1(SM2),Bd3, V1); Other:1. The curative resection rate yielded 95.2% (20/21) without severe complications.

Conclusions ESD achieves a high en bloc resection rate of large pedunculated polyps with wide stalks. This is particularly advantageous in the case of malignant polyps with regard to complete resection and subsequent risk classification.

Publication History

Article published online:
14 April 2022