Brief Article
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. Jun 14, 2010; 16(22): 2806-2811
Published online Jun 14, 2010. doi: 10.3748/wjg.v16.i22.2806
Recurrence after endoscopic piecemeal mucosal resection for large sessile colorectal polyps
Guh Jung Seo, Dae Kyung Sohn, Kyung Su Han, Chang Won Hong, Byung Chang Kim, Ji Won Park, Hyo Seong Choi, Hee Jin Chang, Jae Hwan Oh
Guh Jung Seo, Dae Kyung Sohn, Kyung Su Han, Chang Won Hong, Byung Chang Kim, Ji Won Park, Hyo Seong Choi, Hee Jin Chang, Jae Hwan Oh, Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do 410-769, South Korea
Author contributions: Seo GJ and Sohn DK performed the majority of the study; Han KS, Hong CW and Kim BC contributed to acquisition and analysis data, editing the manuscript; Park JW and Choi HS contributed to the design of the study and analysis of data; Chang HJ and Oh JH designed the study and edited the manuscript critically.
Supported by Grants from the National Cancer Center of Korea, NCC-0710362 and NCC-0910520
Correspondence to: Dae Kyung Sohn, MD, Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 809 Madu-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, South Korea. gsgsbal@ncc.re.kr
Telephone: +82-31-9201636 Fax: +82-31-9201289
Received: February 4, 2010
Revised: March 10, 2010
Accepted: March 17, 2010
Published online: June 14, 2010
Abstract

AIM: To evaluate the safety and outcomes of endoscopic piecemeal mucosal resection (EPMR) for large sessile colorectal polyps.

METHODS: The patients enrolled in this study were 47 patients with 50 large sessile polyps (diameter, 2 cm or greater) who underwent EPMR using a submucosal saline injection technique between December 2002 and October 2005. All medical records, including characteristics of the patients and polyps, complications, and recurrences, were retrospectively reviewed. The first follow-up endoscopic examination was performed at 3-6 mo after initial endoscopic resection, and the second at 12 mo post-EPMR. Subsequent surveillance colonoscopic examinations were individualized, taking risk factors into account.

RESULTS: The patients were 23 men and 24 women, with a mean age of 60 years. Mean polyp size was 30.1 mm. Of 50 polyps identified, 34 (68%) were benign and 16 (32%) were malignant. There were 6 (12%) cases with EPMR-related bleeding: 5 intra-procedural and 1 early post-procedural bleeding. All bleeding episodes were managed by endoscopic clipping or argon beam coagulation. There were no perforations. Recurrence was identified in 5 cases (12.2%): 4 local recurrences detected at 3 mo post-EPMR and 1 local recurrence detected at 14 mo post-EPMR. The recurrence rate after EPMR was 3.1% for benign polyps and 33.3% for malignant polyps (P < 0.05). Median follow-up time was 37 mo.

CONCLUSION: EPMR is safe, but should be applied carefully in malignant polyps. Close follow-up endoscopic examinations are necessary for early detection of recurrence.

Keywords: Colonoscopy; Colorectal neoplasm; Endoscopic piecemeal mucosal resection; Large sessile polyps