This article is more than 5 years old. Information may no longer be current.
Endoscopic resection of large colorectal polyps safe, effective
Endoscopic resection of large colorectal polyps appears to be highly effective and safe, although adequate surveillance is needed for long-term efficacy, according to data from a recent systematic review and meta-analysis.
These findings demonstrate that “most of the benign lesions of the colon may be safely and effectively removed by endoscopy, proven that the patients will accept a quite intensive endoscopic follow-up,” Cesare Hassan, MD, from Nuovo Regina Margherita Hospital in Rome, told Healio Gastroenterology.
Cesare Hassan
The purpose of this study was to evaluate the primary indicators of efficacy and safety of endoscopic resection of polyps at least 20 mm to reliably estimate outcomes. After screening MEDLINE, EMBASE and Cochrane databases studies involving patients treated with endoscopic resection for large neoplastic lesions from 1966 to 2014, Hassan and colleagues included 50 studies involving 6,442 patients and 6,779 large polyps in the final analysis. The primary endpoints were rates of surgery for noncurative endoscopic resection and resection-related adverse events; secondary endpoints included rates of complete endoscopic removal, invasive cancer, adverse events, recurrence and mortality.
The pooled rate of surgeries due to noncurative endoscopic resection was 7.4% (95% CI, 6-9), whereas the pooled estimate for surgeries due to adverse events was 1% (95% CI, 0.7-1.4). Overall, 4.8% (95% CI, 4.3-5.3) of patients had surgery due to invasive cancer (58% of all surgeries), 2.3% (95% CI, 1.9-2.7) due to noncurative endoscopic resection of precancerous lesions (28% of surgeries), 0.2% (95% CI, 0.1-0.4) due to synchronous cancer or perforation for a small polyp (2.2% of surgeries) and 0.5% (95% CI, 0.3-0.6) due to a not endoscopically manageable (residual) recurrent lesion at surveillance endoscopy (5.9% of surgeries), with the remaining 5.9% of surgeries due to adverse events.
Endoscopic perforation occurred in 1.5% (95% CI, 1.2-1.7) of polyps and bleeding occurred in 6.5% (95% CI, 5.9-7.1).
With 8.6% (95% CI, 7.9-9.3) of patients lost at follow-up, 5,334 entered surveillance; endoscopic recurrence occurred in 13.8% (95% CI, 12.9-14.7) of those patients overall, and invasive cancer occurred in 0.3% (95% CI, 0.1-0.4) of those patients overall, corresponding to 1.9% of all recurrences. Endoscopic treatment of recurrence was successful in 90.3% (95% CI, 88.2-92.5) of cases. Overall, mortality directly related to management of large polyps was reported in 0.08% (95% CI, 0.01-0.15) of all cases.
“In our large pooled population, we clearly showed the efficacy and safety of endoscopic resection of large polyps,” the researchers wrote. “These findings stress the importance of optimizing and standardizing endoscopic resection techniques, especially when considering the implementation of population [colorectal cancer] screening campaigns in several European countries.” – by Adam Leitenberger
Disclosure: Hassan reports he received research support from Endochoice and Given Imaging, and another investigator reports receiving research support form Olympus.