Tooru Ashihara

Endoscopic mucosal resection for large sessile polyps of the colon

ENDOSCOPIC MUCOSAL RESECTION FOR LARGE SESSILE POLYPS OF THE COLON E. Cho, N. Mochizuki, T. Ashihara, K. Yasuda and M. Nakajima, Department of Gastroenterology, Kyoto Second Red Coss Hospital, Kyoto, Japan With the advances of techniques and instruments, endoscopic electrosurgical polypectomy has become a fundamental procedure in the management of colorectal polypoid lesions. However, large sessile polyps can be technically difficult and sometimes dangerous to endoscopically resect. Recently, endoscopic mucosal resection(EMR) has been developed as a safer method for colorectal polyps. We assessed the usefulness of this technique for large sessile colorectal polyps. From September 1990 to November 1995, we have performed EMR in 32 patients with colorectal sessile polyps larger than 2 cm in size. The procedure was done in a similar fashion of standard snare polypectomy after injection of saline solution into the submucosa just underneath the target lesion. The maximum diameter of resected polyps ranged from 2.0 to 6.0 cm with a mean of 3.1 cm. The procedure was performed in Ii patients with single resection and 21 patients with piecemeal resection. The histological analysis of these lesions consisted of 3 with tubular adenoma, 5 with tubulovillous adenoma, i with villous adenoma, 20 with mucosal carcinoma and 3 with submueosal carcinoma. The complications after EMR occurred in 4 patlents(12.5%) including i patient with bleeding, 2 with transmural burn and i with perforation into the retroperitonetum, all of which required neither transfusion nor laparotomy. Twentyfive of 32 patients underwent colonoscopic management and surveillance. Locally reccurent or persistent neoplasia was discovered in 4 of 25 patients(16%). Three of these four patients subsequently underwent surgical resection. Endoscopic management was ultimately successful in 22 of 25 patients(88%). EMR is a safer and reliable therapeutic procedure for large sessile colorectal polyps. Close follow-up with colonoscopy is essential to evaluate this technique.