Endoscopic snare resection of large XXXX : how far can we go?

@entity1 @entity1127 @entity548 @entity5 @entity14 @entity1586
BACKGROUND AND AIMS: Colonoscopic polypectomy is preventing @entity14 . Videoendoscopy and new perendoscopic hemostasis techniques make endoscopic polypectomy of large @entity1586 an alternative to the surgical approach. This study examined whether complete snare resection of giant @entity1586 is feasible and safe and for determining how often surgery is necessary due to invasive @entity5 detected histologically after polypectomy. @entity1 AND METHODS: The study included 59 consecutive @entity1 with 68 @entity1586 larger 30 mm in diameter. Snare polypectomy was performed after an endoscopic ultrasound with a miniprobe found no sign of invasive, or, depending on the appearance of the polyp, a @entity548 prophylaxis had been carried out. Acute procedural or delayed @entity548 was treated endoscopically. RESULTS: Of the 68 @entity1127 26, mostly pedunculated were resected en bloc (38%) and histologically ensured as completely resected; 42 @entity1127 had to be resected by piecemeal technique (62%). Piecemeal resection was performed significantly more often in sessile @entity1127 (38/41, 93%) than in pedunculated @entity1127 (4/27, 15%, P<0.01). Follow-up colonoscopy after 3 months showed remaining adenomatous tissue of piecemeal-resected @entity1127 in 12 cases (28%), which were 12 resected sessile @entity1127 (29%) and no case of resected @entity1127 . To achieve complete resection of sessile @entity1127 a second procedure was necessary significantly more often than for resection of pedunculated @entity1127 (12 cases in sessile @entity1127 , 18% vs. no case in pedunculated @entity1127 ). Remaining adenomatous tissue was removed in all 12 cases during the first follow-up colonoscopy after 3 months, confirmed by a biopsy 6 months after the initial procedure. Overall coexisting @entity5 was found in only 7 @entity1127 (12%). Due to high-risk factors only one of them underwent secondary surgical procedure. CONCLUSION: The present study shows that endoscopic snare resection of giant @entity1586 is a safe procedure, and that secondary operative measures for managing coexisting @entity5 are rarely necessary.
