Clin Endosc.  2015 Jan;48(1):52-58. 10.5946/ce.2015.48.1.52.

Endoscopic Mucosal Resection with Circumferential Incision for the Treatment of Large Sessile Polyps and Laterally Spreading Tumors of the Colorectum

• Hong YM
• Kim HW
• Park SB
• Choi CW
• Kang DH

• KMID: 2221759
• DOI: http://doi.org/10.5946/ce.2015.48.1.52

Abstract

BACKGROUND/AIMS
Endoscopic mucosal resection (EMR) is the standard treatment for colorectal polyps such as adenomas and early cancers with no risk of lymph node metastasis. However, endoscopic resection of large colorectal polyps (> or =20 mm diameter) is difficult to perform. We evaluated the clinical outcomes of EMR with circumferential incision (EMR-CI) for the resection of large sessile polyps (Is) and laterally spreading tumors (LSTs) in the colorectum.
METHODS
Between February 2009 and March 2011, we resected 80 large colorectal polyps by EMR-CI. We retrospectively investigated the en bloc resection rate, histologic complete resection rate, recurrence rate, and complications.
RESULTS
The median polyp size was approximately 25 mm (range, 20 to 50), and the morphologic types included Is (13 cases), LST-granular (37 cases), and LST-nongranular (30 cases). The en bloc and complete histologic resection rates were 66.3% and 45.0%, respectively. The recurrence rate was 0% (median follow-up duration, 23 months), and perforation occurred in five cases (6.3%).
CONCLUSIONS
EMR-CI is an effective treatment modality for 20 to 30 mm-sized colorectal polyps, and may be considered as a second line therapeutic option if ESD is difficult.

Keyword

Colorectal polyps; Endoscopic mucosal resection; Circumferential incision

MeSH Terms

Adenoma
Follow-Up Studies
Lymph Nodes
Neoplasm Metastasis
Polyps*
Recurrence
Retrospective Studies

Figure

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  Fig. 1 Endoscopic mucosal resection with circumferential incision (EMR-CI). (A) A laterally spreading tumor, granular type was noted. (B) After submucosal injection of glycerol, a circumferential incision was performed. (C) Mucosal resection by snare was performed. (D) Successful EMR-CI was achieved.

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  Fig. 2 Endoscopic mucosal resection with circumferential incision and piecemeal resection. (A) A laterally spreading tumor, granular type was noted. (B) After submucosal injection of glycerol, a circumferential incision was performed. (C) After circumferential incision, piecemeal resection was first performed in the large, nodular section. (D) Remnant tumor tissue was sequentially resected with piecemeal technique. (E) Successful piecemeal resection was achieved.

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  Fig. 3 Perforation caused by endoscopic mucosal resection with circumferential incision. (A) Perforation after snare resection was observed. (B) Perforation during circumferential incision was observed.

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