Colonic polypectomy

Abstract: BACKGROUND: Colonic polypectomy reduces the subsequent rate of development of colonic cancer but is not without its risks. We aimed to examine our complication rates in relation to the characteristics of polyps and techniques employed. METHODS: A database for all colonic polypectomies performed over a 3½-year period between 2006 and 2009 was matched against all patients readmitted after an endoscopy. Serious complications post-polypectomy were defined as events leading to readmission within 14 days. RESULTS: We performed 2106 polypectomies on 1252 patients in this period. Fourteen patients or 24 (1.1%) polypectomies experienced complications. Two patients (0.09%) experienced perforation, 10 (0.47%) had bleeding and 3 (0.14%) had post-polypectomy syndromes. Our bleeding rate was 1:211, lower than the national standard of 1:100. No deaths were reported. Complication rates rose from 1% in the smallest group (1-10 mm) to 4.9% in the largest (>31 mm) but the difference was not statistically significant (p=0.067). Right-colon polypectomies had a higher tendency of developing post-polypectomy syndrome and bleeding (p=0.002). Complication rates in snare polypectomies were not significantly different from that of hot biopsies (p=0.64). However, endoscopic mucosal resections (EMR) had significantly more complications compared to snares (p=0.045) and hot biopsies (p=0.026). CONCLUSION: We achieved lower bleeding rates than that published nationally. Hot biopsies did not carry a higher risk unlike EMRs. Although polyp size may be an important risk factor, statistical significance was not met. Ascending and transverse colon polypectomies carried the highest risks of complications.

Abstract: By using a colonoscope diathermy snare a total of 75 polyps have been removed from sites throughout the colon in 43 patients. There was some haemorrhage in four cases but no other morbidity, and all patients were discharged home within 24 hours. The ease of this procedure suggests that it should replace colotomy and surgical polypectomy in the management of polyps inaccessible to the rigid sigmoidoscope.

Abstract: Colonic polypectomy is an effective way of reducing colon cancer mortality. Multiple techniques now exist for the resection of polyps, and the endoscopist must decide on the appropriate resection approach for individual patients and lesions. This decision should maximize efficacy, safety and cost-effectiveness and provide optimal oncological outcomes while minimizing unnecessary surgical treatment. Advances in endoscopic imaging technology are improving the accuracy of endoscopic diagnosis and allowing more precise risk assessment of colonic lesions. Resection technique can be tailored to the endoscopic findings. Diminutive (≤5 mm) and small polyps (≤9 mm) are best resected primarily by snare techniques. Cold snare polypectomy has proven safety, but efficacy and technique require further study. There is variation in techniques used for polyps 6-20 mm in size and incomplete resection rates for conventional polypectomy may be considerable. Endoscopic mucosal resection (EMR) is well established, safe and effective for lesions without submucosal invasion (SMI); however, recurrence is a key limitation. Endoscopic submucosal dissection (ESD) is well established in the East; however, it is resource intensive and its role in lesions with a low risk of SMI is questionable. ESD in the West remains incompletely defined and is associated with high adverse event rates, but it is becoming increasingly available and successful as experience grows. Emerging full-thickness resection technologies are still in their infancy and remain experimental as a result of the absence of reliable closure devices and techniques. Patient-focused outcomes should guide technique selection.