Mo1080 Is Piecemeal Polypectomy Really a Poor Option?

Maysoon M. Gamaleldin; Vanessa Kozak; James M. Church

doi:10.1016/j.gie.2016.03.591

Background Large sessile colorectal polyps, usually defined as >2cm, can be resected by en bloc polypectomy, piecemeal polypectomy, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). The option of piecemeal polypectomy is commonly scorned due to the incomplete specimen and uncertain clearance, but it is most easily learned and least consuming of time and resources. We performed a matched cohort study of polyps resected by en bloc snare and piecemeal polypectomy. Methods Patients undergoing endoscopic removal of large (≥2cm) sessile colorectal polyps by one endoscopist between 1995 and 2010 were accessed from an IRB approved polyp database. We matched polyps undergoing piecemeal polypectomy with polyps having en bloc snared excision. Initial infiltration with saline was not used. Only patients with at least one follow up endoscopy were eligible. Persistent polyp was defined as a lesion of the same histology at the site of the index polyp at first follow up. Recurrent polyp was the appearance of another polyp at the site of the index lesion after an interval exam that was clear. Complications were reported. Results There were 769 large sessile polyps, of which 695 (90.4%) were treated with piecemeal excision. 45 of the 74 polyps removed en bloc had follow up information and were matched for size and location with 45 excised piecemeal. Data are given in the table. 20 polyps in each group were 20mm diameter. 10 piecemeal polyps were 21-25mm, 6 were 30-40mm and 3 were 45mm. For the en bloc group, 11 were 21-25mm, 5 were 30-40 and 2 were 45 mm. Polyp locations and pathology were similar. There was no difference in persistent or recurrent polyp rates. 1 patient with an en bloc resection of a 45mm polyp had a sealed perforation managed by repair at laparotomy; 1 piecemeal polypectomy was followed by a post polypectomy syndrome. 1 patient from each group had delayed bleeding; both stopped spontaneously. Conclusion Piecemeal polypectomy is an acceptable option for the management of large sessile colorectal polyps.

Mo1080 Is Piecemeal Polypectomy Really a Poor Option?

View Online

Abstract

Details

Metrics