Endoscopic resection of large sessile colorectal polyps is increasingly used as an alternative to surgery, but remains challenging because of its technical difficulty, the high risk of complications such as bleeding or perforation, and the possibility of coexisting malignancy.
This research, lead by Dr. Sohn DK and his colleagues at the National Cancer Center, Korea, demonstrated the safety of endoscopic piecemeal resection (EPMR) for large sessile colorectal polyps and the research has recently been published on June 14, 2010 in the World Journal of Gastroenterology. The authors included a large number of polyps with significant numbers of malignancies and were able to demonstrate that relapse was low in patients with benign polyps after endoscopic resection.
The research group enrolled 47 patients with 50 large sessile polyps (2 cm or greater in diameter) who underwent EPMR using a submucosal saline injection technique and observed them during follow-up examinations over a median period of 37 months. They showed that 12% of patients had procedure-related minor bleeding. No perforations were observed. Recurrence was identified in 5 cases (12.2%). The significant finding of this research is that the incidence of recurrence after EPMR in malignant lesions was higher than that in benign lesions (33.3% vs 3.1%).
It is still difficult to explain the reason why the incidence of recurrence after EPMR in malignant lesions was higher than that in benign lesions. However, the authors suggested that the endoscopist should try to remove all cancer cells completely because microscopic residual cancer cells after EPMR can cause recurrences. They also suggested that EPMR should be applied carefully in malignant polyps, and close follow-up endoscopic examinations are necessary for early detection of recurrence.
Reference: Seo GJ, Sohn DK, Han KS, Hong CW, Kim BC, Park JW, Choi HS, Chang HJ, Oh JH. Recurrence after endoscopic piecemeal mucosal resection for large sessile colorectal polyps. World J Gastroenterol 2010; 16(22): 2806-2811
Correspondence to: Dae Kyung Sohn, MD, Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 809 Madu-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, South Korea. email@example.com
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About World Journal of Gastroenterology
World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2009 IF: 2.092. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.
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