Second colonoscopy at expert center recommended for some noncancerous polyps

In the absence of biopsy-proven invasive cancer, it may be appropriate to perform a second colonoscopy at an expert center in order to reevaluate patients referred for surgical resection, according to a single-center, retrospective study.

“We found that the majority of colon polyps referred for surgery without biopsy-proven cancer can be resected endoscopically,” researcher Shai Friedland, MD, Stanford University, said in a press release. “Although recurrence rates are high, these too can be successfully treated endoscopically.”

Shai Friedland

During the December 2010 to March 2013 study period, researchers found 38 lesions in 36 patients (median age, 68 years; 53% women). Seventy-one percent of lesions referred for surgery were noncancerous polyps that were endoscopically treated. Previous removal was attempted by the referring physician in 26% of the cases, but was unsuccessful. The adenoma recurrence rate was 50%, and all recurrences were treated endoscopically, with none being cancerous. Overnight hospital admission was required in 6% of patients.

Standard practice during the study period was to schedule a repeat colonoscopy for all patients referred for colorectal surgery of colon polyps without biopsy-confirmed cancer “because the institution’s colorectal surgery team believed strongly that surgical treatment of endoscopically resectable adenomas is unnecessarily aggressive,” the researchers wrote.

“The decision of whether to refer a patient to an interventional colonoscopy center versus surgical resection may depend on multiple factors,” the researchers concluded. “However, endoscopist inexperience or an unwillingness to tackle technically challenging lesions because of time constraints or perceived risk may also contribute to the decision.”

Disclosure: The researchers report no relevant financial disclosures.

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Source: Friedland S. Gastrointest Endosc. 2014;79:101-107.