Endoscopic resection of circumferential and near-circumferential colorectal polyps: experience from a UK tertiary referral centre

Aims Endoscopic resection (ER) of large colorectal polyps has a rapidly expanding indication, with giant circumferential or near-circumferential polyps now being resected. There is limited data on clinical outcomes. We aimed to evaluate the outcomes of ER of circumferential and near-circumferential polyps at a UK tertiary referral centre.

Methods A retrospective study of all patients between January 2015 and December 2023 who underwent ER of colorectal polyps>20mm was performed. Patients with circumferential or near-circumferential (≥ 75% mucosal circumference) were identified.

Results Of 1103 attempted endoscopic resections, 65 (5.9%) involved≥75% of the mucosal circumference. 48 (73.8%) were in the rectum, with 14 (21.5%) involving the dentate line. 14 (21.5%) were recurrent lesions. 30 (46.2%) were resected by endoscopic submucosal dissection (ESD), 12 (21.0%) by endoscopic mucosal resection (EMR), 11 (16.9%) by knife-assisted EMR, 3 (4.6%) by underwater EMR, 1 (1.5%) by cold EMR, and 8 (12.3%) by a TASER (combined ESD/TAMIS) procedure. 4 resections (6.2%) were abandoned due to muscle retraction, dense fibrosis or patient intolerance. En bloc resection was achieved in 19 (31.1%). Intraprocedural bleeding requiring haemostatic forceps occurred frequently (46.2%). Delayed bleeding requiring rehospitalisation or further intervention occurred in 6.2%. Deep mural injury occurred in 4 (6.2%). There was 1 perforation (1.8%) managed with endoscopic clips and antibiotics. Follow up data was available for 57 patients (93.4%) with recurrence seen in 0/17 en bloc and 22/40 (55%) piecemeal resections. Recurrence was particularly high (9/12 patients) in previously manipulated polyps. Successful eradication for piecemeal resections improved to 65% and 77.5% at second and third follow-up, respectively. 6 piecemeal resections were ultimately referred for surgery. Stenosis was seen in 37/57 (64.9%) successful resections, with 2 requiring ballon dilatation and 1 requiring surgery. All 3 resections requiring intervention for stenosis were in the rectum and involved 100% of mucosal circumference.

Conclusions Circumferential or near-circumferential lesions can be managed endoscopically with acceptable complication rates. Recurrence rates are high for piecemeal excisions but most can be managed with repeat endoscopic intervention. Stenosis occurred frequently but very few patients required intervention for this complication.

Publication History

Article published online:
27 March 2025