Portal de Periódicos da CAPES

Endoscopic resection of large colorectal polyps

2004; Arán Ediciones; Volume: 96; Issue: 1 Linguagem: Inglês

10.4321/s1130-01082004000100006

2340-4167

F Pérez Roldán, Pedro González Carro, María Luisa Legaz Huidobro, M. C. Villafáñez García, S. Soto Fernández, A. de Pedro Esteban, O. Roncero García- Escribano, F. Ruiz Carrillo,

Metastasis and carcinoma case studies

Backgrounds: endoscopic polypectomy is a common technique, but there are discrepancies over which treatment -surgical or endoscopic-to follow in case of polyps of 2 cm or larger.Objectives: to analyse the efficacy and complications of colonoscopic polypectomy of large colorectal polyps.Patients and methods: 147 polypectomies were performed on 142 patients over an eight-year period.The technique used was that of submucosal adrenaline 1:10000 or saline injection at the base of the polyp, followed by resection of the polyp using a diathermic snare in the smallest number of fragments.Remnant adenomatous tissue was fulgurated with an argon plasma coagulator.Lately, prophylactic hemoclips have been used for thick-pedicle polyps.Complete removal was defined as when a polyp was completely resected in one or more polypectomy sessions.Polypectomy failure was defined as when a polyp could not be completely resected or contained an invasive carcinoma.Results: the mean patient age was 67.9 years (range, 4-90 years), with 68 men and 79 women.There were 74 sessile polyps, and the most common location was the sigmoid colon.The most frequent histology was tubulovillous.Most of the polyps (96.6%), were resected and cured.This was not achieved in four cases of invasive carcinoma, and a villous polyp of the cecum.All pedunculated polyps were resected in one session, whereas the average number of colonoscopies for sessile polyps was 1.35 ± 0.6 (range, 1-4).The polypectomy was curative in all of the in situ carcinomata except one.As for complications, 2 colonic perforations (requiring surgery) and 8 hemorrhages appeared, which were controlled via endoscopy.There was no associated mortality.Conclusions: endoscopic polypectomy of large polyps (≥ 2 cm) is a safe, effective treatment, though it is not free from complications.Complete resection is achieved in a high percentage, and there are few relapses.It should be considered a technique of choice for this type of polyp, except in cases of invasive carcinoma.