Endoscopic resection as a safe and effective technique for treatment of pedunculated and non-pedunculated benign-appearing colorectal neoplasms measuring 40 mm or more in size.

ABSTRACT

AIM: The aim of this paper was to evaluate the outcome of endoscopic resection (ER) for pedunculated and non-pedunculated colorectal neoplasms exceeding 4 cm in size. METHODS: All patients with a colorectal neoplasms measuring 4 cm or more, who underwent ER at our institution between January 1996 and December 2008 were included in the study. RESULTS: In the study period, 67 ERs were carried out in 67 patients with a mean (±SD) age of 72±11 years. The mean neoplasms size was 48.2±12.5 mm. There were 32 sessile, 26 flat and 9 pedunculated neoplasms. The most frequent location (49.3%) was rectum. No perforation occurred, there were 4 procedural and 2 delayed bleeding, treated endoscopically, and 3 cases of transmural burn syndrome, managed conservatively. Pathologic examination showed 18 low-grade dysplasia, 43 high-grade dysplasia, 3 intramucosal and 3 invasive cancer. The most frequent type of neoplasm was villous adenoma (76.1%). The presence of malignancy was related to villous histology (P=0.005) and to age ≥ 80 of patients (P=0.04). RESULTS: During endoscopic follow-up (49.4± 26.3 months) recurrence was found in 25.8% of lesions (11 sessile and 4 flat), always treated endoscopically. Recurrence was more likely in patients with lesions larger than 60 mm (P=0.04). The three patients with invasive cancer did not undergo surgery, because of advanced age and/or severe extracolonic diseases. During follow-up no local recurrence or metastasis was found. CONCLUSION: ER is a safe and effective procedure for removing benign appearing very large colorectal neoplasms.