Endoscopic mucosal resection for large and giant sessile and flat colorectal polyps: a single-center experience with long-term follow-up

Background and study aims: This study examines efficacy, outcome, and complications of endoscopic mucosal resection (EMR) for large (>= 20 mm) and giant (>= 40 mm) sessile and flat colorectal polyps. Patients and methods: All EMRs carried out at our institution over a 9-year period, for large and giant sessile and flat colorectal polyps with an intensive and regular follow-up were evaluated. The rate of en bloc and piecemeal resection, complications, and recurrence were analyzed. Results: A total of 148 polyps were resected in 148 patients. There were 113 large polyps (76.3%) with a mean size of 25 +/- 4.7 mm (range 20 - 39 mm) and 35 giant polyps (23.7%) with a mean size of 48.8 +/- 12.5 mm (range 40100 mm). The most frequent location was the rectum, occurring in 43.2%. All lesions were removed in a single session. En bloc resection was performed in 65 cases (43.9%) and piecemeal in 83 (56.1%). Procedural bleeding occurred in 13 EMRs (8.8%), and one case of early and one case of delayed bleeding also occurred. There were two cases of postpolypectomy syndrome and one case of perforation. Malignancy (intramucosal and invasive cancer) was mostly present in polyps with sessile shape (P = 0.0013). Follow-up colonoscopy was performed in 142 patients for a mean of 29.8 months. Recurrence was observed in 6/142 (4.2%) patients and was found more in patients with giant polyps (P = 0.014). Conclusions: In our experience EMR is a simple and safe procedure for removing large and giant sessile and flat colorectal polyps, and is associated with a very low risk of complication and local recurrence.