Large endoscopic mucosal resection for colorectal tumors exceeding 4 cm

Table 1 Lesion characteristics

Lesion description and evaluation	n (%)
Total number of lesions	26
Locations
Rectum	15 (58)
Left colon	4 (15)
Transverse colon	1 (4)
Right colon	6 (23)
Size (mm)
Mean	49
40-50	18 (65)
50-60	2 (8)
> 60	6 (27)
Paris classification
0-Is	9 (34)
0-IIa	15 (58)
0-IIb	1 (4)
0-IIc	1 (4)
Kudo’s classification
III (L+s)	2 (8)
IV	24 (92)
Anatomopathology
Tubulous	8 (31)
Villous	11 (42)
Tubulovillous	7 (27)
Low-grade dysplasia	9 (35)
High-grade dysplasia	10 (38)
In situ carcinoma	5 (19)
Intramucosal carcinoma (type m2)	2 (8)
Submucosal-invading carcinoma	0

Table 2 Lesion characteristics and treatment of recurrence

Case	Location	Size (cm)	Kudo’s	Aspect	Histological type	Relapse interval time (mo)	Number of endoscopic treatments	Final treatment
1	Rectum	10	IV	0-Is	DHG	3	2	Argon plasma
2	Right colon	6	IV	0-IIb	DBG	6	1	Argon plasma
3	Rectum	4	IV	0-IIa + 0-IIc	DBG	3	3	Surgery

Table 3 Resection of large sessile polyps via fragmentation: recurrence rates and efficacy

Author	Yr	n	Sessile lesions (%)	Size (cm)	Piecemeal (%)	Surveillance	Relapse (%)	Endoscopic efficacy (%)
Bedogni et al[48]	1986	66	75	≥ 3	100	3-85 mo	11	-
Walsh et al[49]	1992	65	100	≥ 3	100	2.8 mo	28	88
Binmoeller et al[50]	1996	170	73	3-6	100	> 6 mo	16	-
Kanamori et al[4]	1996	32	100	3-8.5	76	2.4 yr	0	100
Iishi et al[27]	2000	56	100	2-5	75	34 mo	39	83
Higaki et al[29]	2003	24	100	2-6	79	24 mo	22.2	91.3
Doniec et al[21]	2003	184	76	3-≥ 13	100	40 mo	3	-
Seitz et al[28]	2003	288	78	> 3	100	36 mo	17	-
Hurlstone et al[23]	2004	58	100	> 1.5	62	24 mo	17	96
Bories et al[51]	2006	50	100	1-> 5	55.8	17.3 mo	15	-
Katsinelos et al[52]	2006	59	100	≥ 2	61	> 1 yr	3.4	96.78
Arebi et al[31]	2007	161	100	2-> 8	100	9.2 mo	-	95.4