PubMed · 14682305
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Mindie H Nguyen, Roy Soetikno. 2003. Prophylactic clip application.. https://doi.org/10.1016/s0016-5107(03)02284-3
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BACKGROUND: Little has been written about the value of retroflexion in the removal of large sessile colon polyps. OBJECTIVE: The objective of the study was to evaluate the utility of retroflexion for removal of large sessile colon polyps. DESIGN: This was a retrospective evaluation of consecutive cases. SETTING: This study was conducted at an academic-hospital-based tertiary-referral colonoscopy practice. PATIENTS: The study comprised consecutive patients with sessile polyps > or = 2 cm who were undergoing endoscopic resection. INTERVENTIONS: The intervention was endoscopic resection of 59 consecutive sessile colon polyps 2 cm or larger in size and located proximal to the rectum by using prototype colonoscopes with short bending sections. MAIN OUTCOME MEASURES: The main outcome measurement was successful endoscopic resection. RESULTS: Fourteen of the polyps were removed either entirely (n = 4) or partially (n = 10) in retroflexion. Patients with polyps that were removed in retroflexion were more likely to have been referred by another colonoscopist than those patients with polyps removed entirely in the forward view (p = 0.05). There were no perforations and no complications related to retroflexion. LIMITATIONS: The study is retrospective, and the practice is a tertiary referral colonoscopy practice. The colonoscopes used are not widely available at this time. CONCLUSIONS: Retroflexion is a useful adjunctive procedure for the removal of some colon polyps proximal to the rectum that are difficult to access endoscopically. The use of retroflexion can increase the fraction of proximal sessile colon polyps amenable to endoscopic resection.
PURPOSE OF REVIEW: With the increased number of colonoscopies performed, many polyps of different sizes and morphology are encountered today. We will reassess endoscopic treatments on large sessile and flat lesions in the colorectum. RECENT FINDINGS: Large lesions are considered to be greater than 2 cm in diameter with a prevalence of 0.8-5.2% in patients undergoing colonoscopy. The prevalence of malignancy in these lesions is 5-22.1%. En-bloc resection is done for lesions smaller than 2 cm in size, and piecemeal resection for those with a larger diameter. The recurrence rate was suggested to be as high as 46%. With repeated endoscopic treatments, the recurrence rate was reduced to 3.8%. Argon plasma coagulation is effective as an adjunct to piecemeal resection. It is essential to have an accurate pretreatment assessment and a proper histological evaluation of resected lesions as the prognosis depends on the depth of invasion, lymphovascular involvement, and histological type. SUMMARY: Endoscopic treatment for large sessile or flat lesions is highly successful in patients without the features predicting adverse outcome. Risk stratification is essential for successful outcome. With our continued efforts, improvement of endoscopic technique, and adjunctive therapy, further reduction in recurrence rate may be achieved.