1. Endoscopic resection of subtotal or completely circumferential laterally spreading colonic adenomas: technique, caveats, and outcomes.
- Author
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Tutticci N, Klein A, Sonson R, and Bourke MJ
- Subjects
- Australia, Female, Humans, Male, Middle Aged, Proctoscopy adverse effects, Proctoscopy methods, Prospective Studies, Severity of Illness Index, Treatment Outcome, Adenoma pathology, Adenoma surgery, Colonic Polyps pathology, Colonic Polyps surgery, Endoscopic Mucosal Resection adverse effects, Endoscopic Mucosal Resection methods, Intestinal Mucosa pathology, Intestinal Mucosa surgery, Intestinal Obstruction diagnosis, Intestinal Obstruction pathology, Intestinal Obstruction surgery, Long Term Adverse Effects diagnosis, Long Term Adverse Effects etiology, Long Term Adverse Effects prevention & control, Rectum pathology, Rectum surgery
- Abstract
Background and Study Aims: Endoscopic mucosal resection (EMR) is an established treatment for large (≥ 20 mm) laterally spreading lesions (LSLs). LSLs with complete or subtotal (> 90 %) circumferential extent (C-LSLs) are generally referred for surgery. Data on technique, efficacy, and safety of EMR for these lesions are absent. The aim of this study was to describe the technique and long-term outcomes of EMR for C-LSLs., Patients and Methods: Prospective observational study of consecutive patients referred for EMR of LSL at a tertiary care center over 63 months to April 2015. Amongst 979 patients with LSL, 12 patients with C-LSL were seen., Results: All lesions were tubulovillous adenomas with granular 0 - IIa + Is morphology. Median longitudinal extent was 95 mm (range 60 - 160), 58 % were located in the rectum, and 3 lesions (25 %) had complete circumferential involvement. EMR technical success was 100 %. There were no major adverse events. Symptomatic stricturing occurred in 2 cases (17 %) and was treated with endoscopic balloon dilation (median 4 sessions). Median follow up is 13 months. Minor residual adenoma was found in 7 (58 %) at first surveillance colonoscopy and was treated with snare excision. A total of 10 patients have completed a second surveillance colonoscopy with minor residual adenoma found in only 1 case. No patient required surgery or developed cancer in long-term follow-up., Conclusions: Endoscopic resection of C-LSL is feasible and safe. Minor residual adenoma is common but endoscopically treatable with long-term cure. Symptomatic stricturing amenable to balloon dilation may occur. Empiric surgical referral for C-LSL based on extensive circumferential involvement may be avoided.ClinicalTrials.gov NCT01368289., (© Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2016
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