Endoscopy 2025; 57(S 02): S280
DOI: 10.1055/s-0045-1805680
Abstracts | ESGE Days 2025
Moderated poster
All you want to know about the colon! 05/04/2025, 11:00 – 12:00Poster Dome 1 (P0)

Peripheral EMR and Thermal AbLation: The PETAL procedure for the management of large benign colorectal polyps with severe fibrosis

R Eckersley
1   Wolfson Unit for Endoscopy, London, United Kingdom
,
A Humphries
2   Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
,
R Kader
2   Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
,
B P Saunders
2   Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
› Author Affiliations
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    Aims Severe central submucosal fibrosis can make endoscopic resection (ER) of large benign colorectal polyps with a significant sessile component extremely challenging, with no identifiable submucosal plane to facilitate endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). The PETAL procedure involves isolating the central fibrotic area at the base of the sessile nodule with wide field EMR, fulgurating the remnant central polyp with argon plasma coagulation (APC), followed by forceps avulsion with repeat APC ablation (ACA).

    Methods A retrospective study of all patients between January 2015 and December 2023 who underwent ER of colorectal polyps>20mm was performed. All patients who underwent the novel PETAL procedure were identified.

    Results 37 procedures were identified. Median polyp size was 60mm (range 30-85mm). Delayed bleeding occurred in 1 case (2.7%), requiring rehospitalisation and repeat endoscopy but no blood transfusion. There were no incidences of deep mural injury or perforation. Histopathology showed low-grade dysplasia in 17 (45.9%), high-grade dysplasia in 18 (48.6%), and adenocarcinoma in 2 cases (4%). Follow-up data was available for 89.2%. Recurrence at first follow-up was seen in 20/33 (60%), but successful eradication improved to 30/33 (90.9%) and 31/33 (93.9%) at second and third follow-up, respectively. Both patients found to have adenocarcinoma opted for endoscopic surveillance only, with no recurrence seen at 3 year follow-up. 2 cases were referred for surgery for non-endoscopically manageable benign recurrence.

    Conclusions The novel PETAL procedure is a safe and effective technique for managing large, benign colorectal polyps with severe fibrosis. Whilst recurrence at first follow-up is high, this is usually endoscopically manageable.


     

    Conflicts of Interest

    Authors do not have any conflict of interest to disclose.

    Publication History

    Article published online:
    27 March 2025

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