Article Title

Outcomes of endoscopic resection of large colorectal neoplasms: An Australian experience

Abstract

Background and Aims: Endoscopic resection of large colorectal neoplasms is increasingly being used as an alternative to surgery. However data on failure rates, safety and long-term outcomes remain limited. The aim of the study was to report short- and long-term outcomes from endoscopic resection of large colorectal neoplasms from a single centre and use a model to predict mortality had surgery been performed.

Methods: Consecutive patients referred for endoscopic resection of large (≥ 20 mm) colorectal neoplasms from January 2001 to February 2008 were included. Resection details were recorded in a prospectively maintained database. Data was collected on 30-day complication rates, and follow-up colonoscopy findings. The Colorectal-POSSUM score was used to estimate mortality from open surgery.

Results: There were 154 large neoplasms in 140 patients. Mean age was 68 years (range 22–94). Mean neoplasm size was 26 mm (range 20–80 mm, 24 ≥ 40 mm). Complete endoscopic removal was achieved in 95% of cases. Twenty patients were referred for surgery (14%). In the endoscopy group, there were no deaths within 30 days. Twelve patients had a complication including two perforations. Endoscopic follow-up data was available in 90% of cases and five patients (4%) were found to have residual adenoma that was treated endoscopically with subsequent clearance. If surgery had been performed, the mean predicted mortality was 2.2% (range 0.5–10%). There were two deaths (10%) in patients who underwent elective surgery within 30 days.

Conclusion: Endoscopic resection of large colorectal neoplasms is safe and effective even for very large benign neoplasms. When the lesion is endoscopically resectable this should be the preferred treatment.

Keywords

peer-reviewed, colonoscopy, colorectal polyps, CR-POSSUM, large polyps, polypectomy

 

Link to Publisher Version (DOI)

http://doi.org/10.1111/j.1440-1746.2009.05987.x