Endoscopic Treatment Of Large Colorectal Polyps.

Purpose: Due to the potential risk of malignancy and technical difficulties in complete removal, large colorectalpolyps represent a special problem for endoscopists. Patients and methods: Endoscopic polypectomy was performed in 156 patients with colorectal polyps larger than 3 cm in diameter (r:3-13cm). 116 were sessile and 40 pedunculated. Most polyps were located in rectum (72), sigma (45) and coecum (14). The remaining adenomas were situated in other parts of the colon. Sessile polyps were removed according to the piecemeal technique. Injection of a solution of adrenaline into the submucosa prior to resection was performed in 30 cases and additional coagulation of the resection borders with the APC was carried out in 20 patients. Results: Histology showed an adenoma in 140 cases and an invasive carcinoma present in the adenoma in 16 patients. Of the adenomas 21 were tubulous, 96 tubulovillous and 6 villous, carcinoma in situ was found in 30 cases. Complete endoscopic removal was achieved in one session in 101 sessile and all pedunculated polyps. Nine patients required 2 sessions, another four 3 sessions. In two patients with 10cm and 13cm big, almost circulary growing rectal polyps, 8 and 10 sessions were neccessary. None of the patients with invasive carcinoma, who underwent surgical resection (n=8), had any evidence of tumor in the resected specimen. During polypectomy, bleeding occured in 19, after polypectomy in 3 patients. In all but one cases definitive hemostasis was immediately achieved endoscopically either by injection treatment and/ or hemoclips. In one patient with pedunculated rectum polyp, the bleeding was stopped with transanal suture. Perforation occured in one patient who had invasive carcinoma of coecum 48 h post polypectomy. There was no mortality. In the follow up over a mean period of 32 month (3-72m), two patients presented recurrence of invasive carcinoma which was treated surgically. Conclusion: Endoscopy is a save and effective method for the treatment of large colorectal polyps.