IRISH SOCIETY OF GASTROENTEROLOGY
ISG Winter Meeting 2019 Posters of Distinction Prize - Second Prize
Tallaght University Hospital, Dublin
The Safety and Efficacy of Endoscopic Mucosal Resection for Large and Intermediate Rectal Polyps Performed in an Irish University-Affiliated Hospital
McCarthy E 1, Ryan E.J. 2, Griffin S 2, O’Riordan J 2, Ryan BM 1, O Connor A 1, Breslin N 1, McNamara D 1,3.
1 Department of Gastroenterology, Tallaght University Hospital 2 Department of Colorectal Surgery, Tallaght University Hospital 3. TAGG Research Centre, School of Medicine, Trinity College Dublin
EMR represents a safer alternative to surgical removal of large and intermediate rectal polyps and is recommended by the ESGE. R0 and en-bloc resections - associated with lower recurrence, perforation rates <0.2% and bleeding in <1% are recommended.
To determine the safety and efficacy of EMR for removal of rectal polyps
EMR’s for rectal polyps over 7 years were identified from a database. Demographics, indications, site and size of polyp, en-bloc or piecemeal, histological diagnosis, complications and recurrence rates were documented.
285 rectal EMR’s were performed over 87 months, mean age 62.3 years, mean size 9.15mm (range 2-50mm). Histology; 81% (n=233) adenomas, 8% (n=22) high grade dysplasia, 1% (n=3) malignant. En bloc resection was achieved in 86% (n=244), recurrence occurred in 4% (n=12). 179 polyps were <10mm and excluded from further analysis. 89 were 10-19mm - intermediate and 17 were >=20mm - large lesions. There was no difference in en bloc resection rates for large and Intermediate lesions, 13/17 (76%) versus 77/89 (86%). R0 resection was infrequently reported for Intermediate, 31/89 (34%) V’s 14/17 (82%) large lesions, p=0.0004. Reported R0 resection rates were similar; 22/31 (70%) intermediate and large 9/14 (64%). Follow up colonoscopy was available in 92 (87%). Larger polyps were more likely to recur, 4/14 (40%) v’s 2/78 (2.5%), OR 15, 95% CI 2.5 to 93.9, p=0.003. R0 resections were less likely to recur, 2/28 (7%) versus 4/11 (36%), p=0.03. Overall complication rate was 4.7% (n=4); all self-limiting bleeding not requiring transfusion or admission.
EMR is safe and efficacious for resection of large and intermediate rectal polyps. Higher recurrence rates with larger lesions warrants their careful selection and uptake of enhanced EMR techniques, such as pre-cutting EMR.