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Residual colorectal lesions treated effectively during follow-up
Patients with large nonpedunculated colorectal lesions who underwent endoscopic resection and long-term follow-up exhibited significant but effectively treatable residual adenomas at later colonoscopies, research data indicated.
The prospective German study, conducted at two centers from September 2010 to April 2013, included 243 consecutive patients (aged 36 to 86 years; 58% men) with 252 resected nonpedunculated lesions of more than 20 mm (mean size, 33 mm). After endoscopic resection (ER), patients underwent standardized follow-up at 3 to 6 months and 12 months where their post-polypectomy scars were reassessed for neoplasia and biopsied at future colonoscopies.
Among 183 lesions after patient drop out (n=69), 58 showed residual neoplasia during the first follow-up period, and 19 of 116 lesions displayed recurrence at 1 year. During 326 surveillance colonoscopies, 21 post-polypectomy scars were undetected. Biopsy samples showed neoplastic tissue present in 16 of 228 macroscopically inconspicuous polypectomy scars (7%), while 20 others showed granulation tissue at histology. Researchers said endoscopists misidentified the 36 lesions (11.8%) that later were treated with ER or argon plasma coagulation.
Forty-three complications (17.1%) occurred in the 252 lesions; 20 (7.9%) were considered major (perforations and bleeding with hemoglobin reductions of >2 g/dL), although they did not include cardiopulmonary complications. Most complications required blood transfusions because of gastrointestinal bleeding and/or endoscopic therapy.
“ER of nonpedunculated large colorectal lesions is a safe and feasible method, but even in experienced hands it is associated with a substantial risk for major complications,” the researchers concluded. “The results … show a high initial rate of residual adenomas after initial ER. However, this is not a major drawback clinically, as residual neoplastic tissue can be treated effectively with repeat resection or ablation and the vast majority of patients had complete remission during the subsequent follow-up.”
Disclosure: The researchers report no relevant financial disclosures.