Clin Endosc.  2024 Jul;57(4):501-507. 10.5946/ce.2023.229.

Endoscopic management of giant colonic polyps: a retrospective Italian study

• Quitadamo P
• Isoldi S
• De Nucci G
• Muzi G
• Caruso F

• KMID: 2558107
• DOI: http://doi.org/10.5946/ce.2023.229

Abstract

Background/Aims
Polyps greater than 30 mm are classified as “giants”. Their endoscopic removal represents a technical challenge. The choice of the endoscopic removal technique is important because it provides a resection sample for precise histopathological staging. This is pivotal for diagnostic, prognostic, and management purposes.
Methods
From a retrospective analysis, we obtained a sample of 38 giant polyps. Eighteen polypectomies were performed using the epinephrine volume reduction (EVR) method, nine polypectomies utilized endo-looping or clipping methods, and 11 patients underwent surgery.
Results
We obtained en bloc resection with the EVR method in all cases; histology confirmed the correct indication for endoscopic resection in all cases. Moreover, no early or delayed complications were observed, and no patient required hospitalization. Using endo-looping or clipping methods, we observed advanced histology in 1/9 (11.1%) cases, while another patient (1/9, 11.1%) had delayed bleeding. Among patients who underwent surgery, 5/11 (45.5%) were deemed overtreated and three had post-surgical complications.
Conclusions
We propose EVR as an alternative technique for giant polyp resection due to its safety, effectiveness, cost-efficiency, and the advantage of avoiding the need to postpone polypectomy to a later time. Further prospective studies might help improve this experience and enhance the technique.

Keyword

Endoscopic removal; Polypectomy; Polyps

Figure

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  Fig. 1. Endoscopic images of the epinephrine volume reduction techniques. (A) A giant pedunculated polyp in sigmoid colon. (B) Epinephrine volume reduction. (C) One time polypectomy.

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