ENDOSCOPIC RESECTION OF LARGE SESSILE COLORECTAL POLYPS USING A SUBMUCOSAL SALINE INJECTION TECHNIQUE

Background/Aims: Endoscopic removal of sessile colorectal polyps 2 cm or greater in diameter is very difficult. We evaluated the safety and usefulness of submucosal saline injection in endoscopic resection of t hese polyps. Materials and Methods: Under colonoscopic observation, 0. 9% NaCl was injected submucosally through needle forceps to elevate po lyps, which were then resected by electrocoagulation. Before 1989, the depth and healing status of ulcers produced by endoscopic resection w ith (N = 12) and without (N = 16) submucosal saline injection were exa mined in specimens obtained at subsequent colectomies. Between 1990 an d 1993, patients were assigned by weighted randomization to undergo co lonoscopic polypectomy with (N = 24) or without (N = 5) submucosal sal ine injection. Results: All 12 ulcers after submucosal saline injectio n were confined to the submucosal layer while 7 (44%) of 16 ulcers wit hout submucosal saline injection, reached the muscle layer or deeper. Seventeen of 24 (71%) polyps were completely removed (14 piecemeal and 3 en bloc) without serious complications after saline injection. Rese ction without submucosal saline injection was complete, but piecemeal, for two of five polyps; postresection bleeding occurred in one case. Conclusions: Endoscopic resection after submucosal saline injection is a safe and effective treatment for large, sessile colorectal polyps.