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Z Gastroenterol 2010; 48(7): 741-747
DOI: 10.1055/s-0028-1109971
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Resection of ”Giant” Colorectal Lesions: Long-Term Outcome and Safety[1]

Endoskopische Resektion kolorektaler „giant polyps”: Effektivität und SicherheitR. Hochdörffer1 , A. Eickhoff1 , D. Apel1 , J. C. Eickhoff2 , D. Hartmann1 , R. Jakobs1 , J. F. Riemann1 , 3
  • 1Medical Department C, Klinikum Ludwigshafen gGmbH, Ludwigshafen, Germany
  • 2Department of Biostatistics & Medical Informatics, University of Wisconsin, Madison, WI, USA
  • 3LebensBlicke, Foundation for Early Detection of Colon Cancer, Ludwigshafen, Germany
Further Information

Publication History

manuscript received: 11.9.2009

manuscript accepted: 30.11.2009

Publication Date:
06 July 2010 (online)

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Zusammenfassung

Hintergrund: Heutzutage stellt die endoskopische Resektion die Standardprozedur bei der Abtragung kolorektaler Polypen dar. Vor der Etablierung endoskopischer Techniken kam der Abtragung kolorektaler Polypen mit einer Größe von über 3 cm eine eindeutige Präferenz zu. Die Sicherheit und Effektivität der endoskopischen Abtragung von Polypen über 3 cm wurden in zahlreichen Studien belegt. Patienten und Methodik: Es wurden Daten von 165 Patienten (Alter 68 ± 10,4 Jahre) mit insgesamt 167 Polypen evaluiert. Die Polypen wiesen eine Mindestgröße von 3 cm auf. Im Blickpunkt des Interesses war die makroskopische und histologische Morphologie der Polypen, die Lokalisation im Kolon, die Modalitäten der Polypabtragung sowie das Follow-up. Patienten mit makroskopisch eindeutig malignitätsverdächtigen Polypen wurden ausgeschlossen. Ergebnisse: Erfolgreich endoskopische Abtragungen gelangen in 72,5 %. Dabei war in 73,6 % aller Resektionen die Anwendung der Piecemeal-Technik erforderlich. Rezidive traten nach kompletten Resektionen in 26,3 % (nach einem mittleren Follow-up von 16 ± 12,5 Monaten) auf. Es lag eine Komplikationsrate von 19,2 % vor. Relevante Blutungen und Perforationen wurden als frühe Komplikationen in 18,6 % registriert. Eine interventionsbedingte Mortalität wurde nicht festgestellt. Schlussfolgerung: Endoskopische Mukosaresektionen stellten eine sichere und effiziente Methode zur Abtragung großer kolorektaler Polypen dar. Kontrolluntersuchungen sollten in zeitlich definierten Abständen zur Detektion von Rezidivpolypen erfolgen.

Abstract

Background: Today, endoscopic resection is a standard procedere for the resection of colonic polyps. Before the establishment of endoscopic techniques, the surgical approach was a clearly preferred method for removal of polyps with a size larger than three centimeters. The safety and effectiveness concerning endoscopic resections of colorectal polyps also with a size of more than 3 cm have been demonstrated in numerous studies. Patients and Methods: Data from 165 patients (age: 68 ± 10.4 years) harboring 167 polyps with a minimum diameter of 3 cm were retrospectively evaluated. Objects of interest were macroscopic morphology and histopathology of the polyps, their localization in the colon, the modality of endoscopic resection and follow-up. In those cases with macroscopic signs of malignancy the patients were excluded. Results: Successful endoscopic resections were obtained in 72.5 %. Therefrom, resection in the piecemeal-technique was necessary in 73.6 %. Recurrence polyps after endoscopic complete resections occurred in 26.3 % after a mean follow-up of 16 ± 12.5 months. We registered a complication rate of 19.2 %. Relevant bleeding and perforation were registered as early complications in 18.6 %. We observed no intervention-related mortality. Conclusion: Endoscopic mucosal resection is a safe and efficient method even for removing giant colorectal polyps. Controls are recommended at defined intervals for detecting polyp recurrence.

Schlüsselwörter

Giant Polyps - kolorektales Adenom - endoskopische Resektion - rezidivierende Polypen

Key words

giant polyps - colorectal adenoma - endoscopic resection - recurring polyps

1 Rico Hochdörffer and Axel Eickhoff are both first authors, because both are involved in creation of the manuscript in equal parts.

References

  • 1 Bedogni G, Bertoni G, Ricci E. et al . Colonoscopic excision of large and giant colorectal polyps. Technical implications and results over eight years.  Dis Colon Rectum. 1986;  29 831-835
    Google Scholar
  • 2 Binmoeller K F, Bohnacker S, Seifert H. et al . Endoscopic snare excision of ”giant” colorectal polyps.  Gastrointest Endosc. 1996;  43 183-188
    Google Scholar
  • 3 Brooker J C, Saunders B P, Shah S G. et al . Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations.  Gastrointest Endosc. 2002;  55 371-375
    Google Scholar
  • 4 Brooker J C, Saunders B P, Shah S G. et al . Endoscopic resection of large sessile colonic polyps by specialist and non-specialist endoscopists.  Br J Surg. 2002;  89 1020-1024
    Google Scholar
  • 5 Christie J P. Colonoscopic excision of large sessile polyps.  Am J Gastroenterol. 1977;  67 430-438
    Google Scholar
  • 6 Cipolletta L, Bianco M A, Rotondano G. et al . Endoclip assisted resection of large pedunculated colon polyps.  Gastrointest Endosc. 1999;  50 405-406
    Google Scholar
  • 7 Conio M, Repici A, Demarquay J F. et al . EMR of large sessile colorectal polyps.  Gastrointest Endosc. 2004;  60 234-241
    Google Scholar
  • 8 Doniec J M, Löhnert M S, Schniewind B. et al . Endoscopic removal of large colorectal polyps: prevention of unnecessary surgery?.  Dis Colon Rectum. 2003;  46 340-348
    Google Scholar
  • 9 Franklin M E, Díaz-E J A, Abrego Jr D. et al . Laparoscopic-assisted colonoscopic polypectomy: the Texas Endosurgery Institute experience.  Dis Colon Rectum. 2000;  43 1246-1249
    Google Scholar
  • 10 Frühmorgen P, Rufle W, Kobras S. et al . Endoscopic therapy of early colorectal cancer (pT1) – a prospective study.  Z Gastroenterol. 2003;  41 703-710
    Google Scholar
  • 11 Gyorffy E J, Amontree J S, Fenoglio-Preiser C M. et al . Large colorectal polyps:colonoscopy, pathology, and management.  Am J Gastroenterol. 1989;  84 898-905
    Google Scholar
  • 12 Hensman C, Luck A J, Hewett P J. Laparoscopic-assisted colonoscopic polypectomy: technique and preliminaryexperience.  Surg Endosc. 1999;  13 231-232
    Google Scholar
  • 13 Kanamori T, Itoh M, Yokoyama Y. et al . Injection-incision-assisted snare resection of large sessile colorectal polyps.  Gastrointest Endosc. 1996;  43 189-195
    Google Scholar
  • 14 Le Picard P, Vacher B, Pouliquen X. Laparoscopic-assisted colonic polypectomy or how to be helped by laparoscopy to prevent colectomy in benign colonic polyps considered to be unresectable by colonoscopy.  Ann Chirurg. 1997;  51 986-989
    Google Scholar
  • 15 Morton J D, Waye J D, Ullman T. Office-based polypectomy of large colonic polyps is safe and effective.  Am J Gastroenterol. 2002;  97 S301
    Google Scholar
  • 16 Muto T, Bussey H J, Morson B C. The evolution of the cancer of the colon and rectum.  Cancer. 1975;  36 2251-2270
    Google Scholar
  • 17 Nivatvongs S, Goldberg S M. (1979) Experience with colonoscopic polypectomy. Review of 700 polyps.  Minnesota med. 1979;  62 197
    Google Scholar
  • 18 Nivatvongs S. Complications in colonoscopic polypectomy. An experience with 1,555 polypectomies.  Dis Colon Rectum. 1986;  29 825-830
    Google Scholar
  • 19 Ommer A, Limmer J, Möllenberg H. et al . Laparoscopic-assisted colonoscopic polypectomy – indications and results.  Zbl Chirur. 2003;  128 195-198
    Google Scholar
  • 20 Pérez Roldán F, González Carro P, Legaz Huidobro M L. et al . Endoscopic resection of large colorectal polyps.  Revista espanola de enfermedades digesivas. 2004;  96 36-47
    Google Scholar
  • 21 Regula J, Wronska E, Polkowski M. et al . Argon plasma coagulation after piecemeal polypectomy of sessile colorectal adenomas: long-term follow-up study.  Endoscopy. 2003;  35 212-218
    Google Scholar
  • 22 Rosen L, Bub D S, Reed 3 rd J F. et al . Hemorrhage following colonoscopic polypectomy.  Dis Colon Rectum. 1993;  36 1126-1131
    Google Scholar
  • 23 Shinya H, Wolff W I. Morphology, anatomic distribution and cancer potential of colonic polyps.  An Surgery. 1979;  190 679-683
    Google Scholar
  • 24 Smith L E. Fiberoptic colonoscopy: complications of colonoscopy and polypectomy.  Dis Colon Rectum. 1976;  19 407-412
    Google Scholar
  • 25 Stergiou N, Riphaus A, Lange P. et al . Endoscopic snare resection of large colonic polyps.  Int J Colorectal Dis. 2003;  18 131-135
    Google Scholar
  • 26 Walsh R M, Ackroyd F W, Shellito P C. Endoscopic resection of large sessile colorectal polyps.  Gastrointest Endosc. 1992;  38 303-309
    Google Scholar
  • 27 Winawer S J, Zauber A G, Ho M N. et al . Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup.  N Engl J Med. 1993;  329 1977-1981
    Google Scholar
  • 28 Yokota T, Sugihara K, Yoshida S. Endoscopic mucosal resection for colorectal neoplastic lesions.  Dis Colon Rectum. 1994;  37 1108-1111
    Google Scholar
  • 29 Yoshikane H, Hidano H, Sakakibara A. et al . Endoscopic resection of laterally spreading tumors of the large intestine using a distal attachment.  Endoscopy. 1999;  31 426-430
    Google Scholar
  • 30 Zlatanic J, Waye J D, Kim P S. et al . Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy.  Gastrointest Endosc. 1999;  49 731-735
    Google Scholar

1 Rico Hochdörffer and Axel Eickhoff are both first authors, because both are involved in creation of the manuscript in equal parts.

Dr. Rico Hochdörffer

Medical Department C, Klinikum der Stadt Ludwigshafen a. R.

Bremserstr. 79

67063 Ludwigshafen am Rhein

Germany

Phone: ++ 49/6 21/5 03 41 01

Fax: ++ 49/6 21/5 03 41 14

Email: rico.hochdoerffer@gmx.de

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