COLONOSCOPIC RESECTION OF LARGE COLONIC POLYPS - A PROSPECTIVE-STUDY

Forty-five patients who were referred for surgical resection of large colonic polyps after index colonscopy were considered for endoscopic p olypectomy. Eighteen of these patients were ultimately referred for su rgery. Twenty-five patients with 25 large polyps underwent endoscopic polypectomy; there were 9 females and 16 males with a mean age of 69 y ears. Among the polypectomy patients, polyp size was 3.0-6.0 cm, found mostly in the left colon. There were 21 pedunculated and 4 sessile po lyps. Follow-up was carried out for a mean of 48 months (range, 12-171 months). Polypectomy was possible on a single attempt in 12 (48%) cas es and in 13 (52%) cases by a piecemeal technique. Pathological examin ation revealed malignancy in 11 (44%), adenomatous polyp in 11 (44%), and inflammatory, hyperplastic and harmatoma in 1 patient each. Compli cations included bleeding in 3 (12%) patients and diarrhea and fever i n 1 (4%). All complications were successfully treated conservatively w ithout sequellae. Two patients were referred for surgery, 1 with invas ion of the base of the polyp and 1 because of a synchronous malignant polyp. During follow-up, 8 metachronous polyps were detected. In 1 of these, a carcinoma was found and treated with endoscopic polypectomy. In conclusion, endoscopic polypectomy of large polyps is safe and can defer surgical treatment. Regular follow-up is required. Endoscopic po lypectomy of large polyps should be considered before referral for sur gical treatment.