Prevalence, Histology, Endoscopic Treatment and Long-term Follow-up of Large Colonic Polyps and Laterally Spreading Tumors. The Romanian Experience

Abstract

Aims. We report the prevalence, histological aspect, endoscopic treatment and follow-up of colonic polyps of 2 cm or larger and of laterally spreading tumors (LSTs) in an eastern European country.

Methods. All consecutive colonoscopies carried out over a 1-year period (3,856) in the Endoscopy Department of the 3rd Medical Clinic Cluj-Napoca were evaluated. Fifty-two polyps and 12 LSTs of ? 2cm diameter were found. Size, location and histological aspect of large colonic polyps and LSTs were assessed. Endoscopic or surgical resection was recorded. An extensive endoscopic and histological follow-up was performed.

Results. Median size of polyps was 32mm and of LSTs 41mm. Invasive carcinoma was found in 7 polyps (20.6%) and in 4 LSTs (28.6%). Thirty-six polyps were endoscopically resected (69.2%). A complete endoscopic excision was performed in 35 polyps (98.6%). Histological complete resection was achieved in 30 polyps (83.3%). Thirteen polyps were surgically resected (25%). Eight LSTs were endoscopically resected (64.3%) using endoscopic piecemeal resection (EPMR). A complete endoscopic excision was performed in three LSTs (37.5%). Three LSTs were surgically resected (21.5%). In the polyp group, one patient presented endoscopic recurrence (16.6%) at 6 months follow-up. In the LST group, two invasive recurrences were present at 3 and 30 months of follow-up.

Conclusions. A complete resection can be performed in the majority of large polyps. LSTs larger than 50mm, incomplete resection and superficial invasive carcinoma were correlated with endoscopic recurrence. EPMR might be a curative method for LSTs but an accurate endoscopic diagnosis and long-term endoscopic follow-up are mandatory.