A134 ENDOSCOPIC RESECTION IS EFFECTIVE FOR COMPLEX LARGE NON-PEDUNCULATED COLORECTAL POLYPS

TL;DR

Endoscopic resection is effective for complex large non-pedunculated colorectal polyps with outcomes similar to simpler cases.

Contribution

Demonstrates that endoscopic resection outcomes for complex polyps are comparable to uncomplicated ones with proper techniques.

Findings

Technical success was 95.6% for complex polyps vs. 99.2% for uncomplicated ones.

No significant difference in adverse events between complex and uncomplicated polyps.

Only 1 recurrence was observed in the uncomplicated polyp subgroup at first surveillance.

Abstract

Endoscopic resection is preferred for most large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs) due to superior efficacy, safety, and cost-efficiency compared to surgery. However, endoscopic resection can be challenging due to anatomical location, lesion characteristics, and concomitant colonic disease; these complex LNPCPs (C-LNPCPs) historically have suboptimal outcomes compared to uncomplicated LNPCPs (UC-LNPCPs).

To compare the outcomes of C-LNPCPs to UC-LNPCPs following endoscopic resection.

Consecutive patients ampersand:003E 18 years of age who underwent endoscopic resection of a LNPCP were enrolled in a prospective single center observation cohort study (clinicaltrials.gov ID: NCT05402696). C-LNPCP were defined by at least one of the following criteria: involvement of the appendiceal orifice, ileocecal valve, or anorectal junction; previous resection attempt; ≥ 90% circumferential involvement; concomitant inflammatory bowel disease. All other lesions were classified as UC-LNPCPs. Performance was evaluated by technical success (all neoplastic tissue removed at index procedure), procedure-related adverse events (intra-procedural perforation, clinically significant post-endoscopic resection bleeding (CSPEB), delayed perforation, serositis), referral to surgery, and recurrence at first surveillance colonoscopy (SC1).

From 06/2022-09/2023, 350 LNPCPs were referred for endoscopic resection and 335 were attempted (91 C-LNPCPs, 244 UC-LNPCPs). Median age was 68 years (IQR 62-74 years) and 144 (54.1%) were male. Median size was 30mm (IQR 20-40mm). Most lesions were adenomatous (63.7% C-LNPCPs, 64.8% UC-LNPCPs), with cancer identified in 3.3% and 4.9% of C-LNPCPs and UC-LNPCPs, respectively. EMR was the most common resection modality (62.6% C-LNPCPs vs. 64.8% UC-LNPCPs) with C-LNPCPs undergoing more ESD (17.6% vs. 7.0%) and less CSR (19.8% vs. 28.3%; p=0.011). Auxiliary modalities were more frequently used in C-LNPCPs (6.6% vs. 1.2% UC-LNPCPs; p=0.004). Technical success was 95.6% in C-LNPCPs compared to 99.2% in UC-LNPCPs (p=0.049). There was no significant difference between groups in the frequencies of adverse events. 17 LNPCPs (5.1%; 4 C-LNPCP, 13 UC-LNPCPs) underwent surgery (p=1.000). Of those LNPCPs assessed at SC1, there was 1 recurrence (1.0%) in the UC-LNPCP subgroup.

With site-specific technical modifications and mitigating strategies for procedural-related adverse events, endoscopic resection outcomes for C-LNPCPs are comparable to UC-LNPCPs.

None