Resection of large, broad-based pedunculated and semi-pedunculated colorectal polyps using a scissor-type endoscopic submucosal dissection knife

TL;DR

A new endoscopic tool called ST-ESD knife was found to be safe and effective for removing large colorectal polyps that are difficult to treat with traditional methods.

Contribution

The study introduces and evaluates the use of a scissor-type endoscopic submucosal dissection knife for challenging colorectal polyps.

Findings

ST-ESD achieved successful en bloc resection in 89.7% of cases with no major complications.

All successful resections were R0 (complete removal) and showed no recurrence in follow-up.

Only one case required surgery due to high-risk features, with no malignancy found in abandoned cases.

Abstract

Endoscopic resection of large, broad-based pedunculated and semi-pedunculated polyps can be technically difficult. Conventional snare resection risks immediate bleeding and piecemeal excision. We evaluated the safety and efficacy of a scissor-type endoscopic submucosal dissection (ST-ESD) knife for these lesions.

A single-center retrospective study was conducted of all patients who underwent ST-ESD resection of pedunculated or semi-pedunculated polyps with head size ≧ 20 mm and stalk width ≧ 10 mm. Primary outcomes were en bloc resection, intraprocedural and delayed bleeding, and perforation. Secondary outcomes were R0 resection and recurrence at first follow-up.

Fifty-eight resections were identified (75.6% male; median age 60 years). Median head size was 30 mm (range 20–70) with median stalk width 15 mm (range 10–50). Of them, 74.1% were in the sigmoid colon. Successful resection was achieved in 52 of 58 (89.7%); 44 (75.9%) by ST-ESD alone and eight (13.8%) snare-assisted. Six (10.3%) were abandoned; five due to visible muscle retraction and one dense stalk fibrosis. All successful resections were en bloc with R0 in 52 of 52 (100%). Minor intraprocedural bleeding occurred in nine of 58 (15.5%) and was controlled endoscopically. Forty-seven of 52 defects (90.4%) were closed prophylactically with endoscopic clips. There were no incidences of delayed bleeding or perforation. Histopathology was benign in 51 of 52 (98.1%). One adenocarcinoma was treated surgically for high-risk features. Endoscopic follow-up was available in 41 of 52 (78.8%) with no recurrence seen. Zero of six abandoned cases referred for surgery contained evidence of malignancy in the surgical specimen.

ST-ESD is safe and effective for resection of large, broad-based pedunculated and semi-pedunculated colorectal polyps.