Clinical Value In The Endoscopic Treatment For Large Colorectal Polyps

PrefaceColorectal adenomatous polyps are precancerous lesion,there is a immediate relationship between them and colorectal carcinoma. Prevention of cancer by removal of adenomas is an important strategy in the effort to lower the incidence of the disease. Large colonic adenomas are particularly important, as they are more likely to have villous architecture and are more prone to contain severe dysplasia or intramucosal adenocarcinoma than small adenomas.lt is reported that the risk of cancerization of large colorectal polyps is 2 times more than small ones. They also pose more of a challenge to the therapeutic colonoscopist.Bleeding and perforation are common complications.To reduce complication in the endoscopic treatment for large colorectal polyps,new methods have being searched for.During the treatment of the all kinds of digestive tract diseases, the method of APC combined with the high-frequency electrocision has the merit of good safety, efficient hemostasis, rare side comp lications and convenient operation. And it can be the chief method specially for the applanate and wide outsole polyps.But it is time-consuming。For pedunculated polyp, the procedure of high-frequency polypectomy of large polyps after nylon snare loop ligature is simple, and the method can also be effective to prevent immediate bleeding during operation and delayed bleeding after endoscopic polypectomy。Endoscopic mucosal resection is new method for endoscopic theraphy.For colorectal flat sessile polys,local submucosal injection of saline to produce mucosal bulging at the imdiate vicinity of polyps was performed,and then eletrocoagulative snare excection of polyps was done under endoscopy.The present study aim is To evaluate the efficacy and outcomes of endoscopic treatment for large colorectal polyps,and choose suitable endoscopic methods for different polyps.Instruments and Methods 1. InstrumentsEnteroscope is Pantax EC 3840F or FUJINON; argon electric cutting-coagulating machine is ERBE APC300.other Instruments includes snares (Olympus SD-210u-25 orPentax A70574), titanium clips(Olympus HX-610-135 or Olympus HX-600-090) and injection needles (Olympus NM—200U—0423).2. methodsFrom January 2008 to December 2008,85 consecutive patients(21 women,16 men;mean age 54.7±8.8 years) with 91 large colorectal polyps was be found under Enteroscopey in our institution were eligible for inclusion in this study. We chosed suitable endoscopic treatments according to the size and the shape of the polyps. The methods including, snare polypectomy,endoscopic mucosal resection, endoscopic piecemeal mucosal resection, and application of argon plasma coagulation and hemoclips.All resected specimens were retrieved for pathologic study.Follow-up colonoscopy was performed in all patients. If biopsy pathology revealed polyps with severe atypical hyperplasia or local canceration, they were resected by surgical methodsResultsAll of the 91 large colonic polyps,72 of them were resected under endoscopy(diathermal snare,66;endoscopic mucosal resection and 2 for endoscopic piecemeal mucosal resection).The other 19 polyps were resected under surgery. As for complications,7 hemorrhages appeared, which were controlled via endoscopy.No performation happened. To prevent postoperative bleeding and performation, hemoclips were applicated for 16 patients.The resected polyps were collected for histology.Histopathologic assessment of the resected specimens revealed the following: tubulous adenoma,31; villous-tubulous adenoma,42. villous adenoma,9;hyperplastic polyps,3;Inflammatory adenoma,6; Among of them,14 polyps took place malignant change,and the rate is 15.4%.ConclusionsEndoscopic polypectomy is a safe and effective method of treating large colorectal polyps, associated with a low complication rate.