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Treatment by endoscopic mucosal resection of sessile and flat polyps of the colon and rectum a study of 75 cases


, : Treatment by endoscopic mucosal resection of sessile and flat polyps of the colon and rectum a study of 75 cases. Digestive Disease Week Abstracts & Itinerary Planner : Abstract No W1141

The aim of this study was to assess the efficacy, safety and clinical outcome of EMR. METHODS: Data from consecutive EMR carried out between 1997 and 2001 were retrospectively analyzed. RESULTS: Seventy five EMR procedures were performed on 68 patients. The mean size of polyps was 1.7 cm (range: 0.2-4). The lesions, of height less than a third of the diameter, were classified as superficial elevated (type IIa of the classification of early neoplasia of the digestive tract) in 65% of the cases ; flat (type IIb) in 28% ; slightly depressed (type IIc) in 7%. Locations were rectum 28%, left colon 19%, transverse 15%, caecum and ascending colon 38%. Saline solution assisted-snare resection was performed in 76% of cases, suction cap-assisted technique in 16%, and a simplified suction and cutting (without cap or saline solution) in 8%. Post-EMR histopathology was adenoma 57%, cancer 21% (high grade dysplasia 7%, Tis 9%, T1 5%), serrated adenoma 3%, hyperplasia 11%, hamartoma or inflammation 8%. Complete resection was achieved in 59 cases (79%). Three patients underwent a surgical resection for Tis (2 cases) or T1 (one case) where the margins of the resected lesion were healthy. The removed tissues contained no tumor residue and the lymph nodes were healthy. Thirty eight cases of adenoma or carcinoma were checked through follow-up coloscopy 3 to 6 months later (in 33 cases) or 9 to 24 months after the EMR. Through an average endoscopic follow up of 11 months, 7 recurrences (17% ; 5 cases of adenoma and 2 of high grade dysplasia) were detected during an examination which intervened between 3 to 6 months later, and were treated endoscopically. Six happened with lesions where the margins had proven affected through histology, and one concerned a lesion with healthy margins. The affected margins of resection proved to be the only predictive factor for recurrence by univariate analysis (p = 0.001). Complications were 8 cases (11%) of immediate bleeding all treated by means of local injection of adrenaline and saline solution (1/10000) and 3 (4%) perforations that occurred on the right colon after use of the suction cap. Two were treated surgically (one coelioscopic suture, one right hemicolectomy) and one by 8 clips implanted with endoscopy. There was no mortality. CONCLUSIONS: EMR is an effective treatment for sessile and flat lesions of the colon and rectum. In the case of an incomplete resection, endoscopic follow up must be scheduled at 3 months. The suction cap-assisted technique is associated with a high risk of perforation.

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