Su1490 Endoscopic Mucosal Resection of Large Sessile Colonic Polyps: A Safe and Effective Alternative to Surgery

Endoscopic Mucosal Resection of Large Sessile Colonic Polyps: A Safe and Effective Alternative to Surgery Katharine A. Germansky*, Ram Chuttani, Douglas K. Pleskow, Mark D. Aronson, Alexander Carbo, Daniel A. Leffler Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA Background & Aims: Endoscopic mucosal resection (EMR) has emerged as an alternative to surgery for large sessile lesions of the colon. There is currently limited data of this procedure and our aim was to evaluate the safety and efficacy of EMR by determining the success and complication rates in our population. Methods: We conducted a retrospective, single center, observational study of all patients who underwent colonic EMR from January 2007 until July 2010. Based on sclerotherapy needle charges, 359 EMRs of colonic lesions were identified. We analyzed data on patient and lesion characteristics as well as procedural, clinical, and histologic outcomes as they were available in our facility’s electronic medical record. Complications were defined as significant adverse events requiring a procedure or hospital admission. Student’s T test and Fisher’s exact test were performed as indicated. Results: The overall population was 50% male and the mean age was 65. 359 polyps were removed with an average size of 21mm (range 5 70mm), performed by 24 faculty endoscopists with volume ranging from 1 to 145 EMR procedures over the study period. Of the 359 EMRs done for colonic lesions, 321 (89%) had the lesion definitively removed and 4 (1.1%) were referred to surgery for cancer found in the polyp, 7 (1.9%) for high grade dysplasia, and 27 (7.5%) for inability to resect the entire lesion. There were 11 complications (3.0%; 95% CI 1.7% 5.4%), which is significantly higher than the 0.95% complication rate of all colonoscopies (p 0.0001) and 1.2% complication rate for colonoscopies with non-EMR polypectomies (p 0.0096). Age, smoking status, and diabetes did not appear to predispose to complications. All 11 polyps in patients with complications were adenomas. Nine of 11 polyps were located in the cecum (p 0.021) and 10 of 11 were described as sessile. None of the 11 polyps had prior attempts at removal or clips placed after EMR. There were 11 bleeds, two (0.6%) of which were self-limited and seven (1.9%) of which were managed endoscopically. Seven patients (1.9%) required transfusions and five patients (1.4%) required ICU level care for at least one day. Two (0.5%) required partial colectomies for bleeding unresponsive to endoscopic or interventional radiology techniques. There were no perforations in the 359 patients. Five of eleven patients presented on the day of procedure while all presented within 14 days with a median of 2 days. Seven of 11 were anticoagulated with six (55%) on aspirin (p 0.128), two on aspirin and clopidogrel, and one patient on warfarin. Conclusions: EMR is a safe and effective alternative to surgery for large sessile colonic polyps with a complication rate of 3% and successful removal in 89% of cases. Cecal lesions and possibly patients on anticoagulation or antiplatelet agents are at increased risk of complication.