BACKGROUND AND STUDY AIMS:

There have been significant advances in the management of complex colorectal polyps. Previous failed resection or polyp recurrence is associated with significant fibrosis, making endoscopic resection extremely challenging; the traditional approach to these lesions is surgery. The aim of this study was to evaluate the efficacy of a novel, knife-assisted snare resection (KAR) technique in the resection of scarred colonic polyps.

PATIENTS AND METHODS:

This was a prospective cohort study of patients, in whom the KAR technique was used to resect scarred colonic polyps > 2 cm in size. Patients had previously undergone endoscopic mucosal resection (EMR) and developed recurrence, or EMR had been attempted but was aborted as a result of technical difficulty.

RESULTS:

A total of 42 patients underwent KAR of large (median 40 mm) scarred polyps. Surgery for benign disease was avoided in 38 of 41 patients (93 %). No life-threatening complications occurred. Recurrence was seen in six patients (16 %), five of whom underwent further endoscopic resection. The overall cure rate for KAR in complex scarred colonic polyps was 90 %.

CONCLUSIONS:

KAR of scarred colonic polyps by an expert endoscopist was an effective and safe technique with low recurrence rates.

Cette technique mixte de résection associant la dissection à la résection standard à l’anse semble être fiable et sur pour des polypes habituellement confiés aux chirurgiens.

Nous avons donc maintenant 2 nouvelles techniques endoscopiques pour la prise en charge de ces polypes compliqués. Cette technique mixte pour les polypes de plus de 2cm et la résection trans-pariétale à l’aide du clip OVESCO ® pour ceux de 0 à 2cm.