Complete endoscopic mucosal resection of malignant colonic sessile polyps and clinical outcome of 51 cases

Factors predicting occurrence and therapeutic choice in malignant colorectal polyps: a study of 13 years of colonoscopic polypectomy

Colorectal carcinoma represents a major cause of mortality and 0.2–12% of resected colonic polyps have malignant cells inside. We performed a retrospective study of patients with resected polyps during a period of 13 years. A total of 905 patients had 2033 polyps removed; 122 polyps (109 patients) had malignant cells. Prevalence of malignant polyps with submucosal invasion was 1.23% and for all polyps with malignant cells was 6%; malignant polyps had a larger size (23.44 mm mean diameter) vs benign polyps (9.63 mm); the risk of malignancy was increased in polyps larger than 10 mm, in lateral spreading lesions and in Paris types 0-Ip, 0-Isp, in sigmoid, descending colon and rectum, in sessile serrated adenoma and traditional serrate adenoma subtypes of serrated lesions and in tubulovillous and villous adenoma. In 18 cases surgery was performed, in 62 patients only colonoscopic follow-up was made and in 35 patients no colonoscopic follow-up was recorded. From initially endoscopic resected polyps, recurrence was noted in seven (11.3%) cases; there was a trend toward association with depth of invasion, piecemeal resection, right and rectum location, sessile and lateral spreading type and pathological subtype. In surgical group, post-therapeutic staging was available in 11 cases; nodal involvement was noted in three (27.27%) cases; none had lymphatic or vascular invasion in endoscopically resected polyps. Four patients with no macroscopic local recurrence underwent surgery with no residual tumor. The rate of metastasis was 16.67% in surgical group and 1.61% in endoscopic group. Evaluation of lymph node (LN) invasion was available for 11 operated patients, with LN invasion (N1) in three patients, local residual tumoral tissue in one patient with incomplete resection and no residual tumor (R0 resection) in four patients with endoscopic resection before surgery.

Clinical exploration of marking targeting biopsy in the intraoperative localization value of colon polypectomy

Objective

To evaluate the feasibility and safety of marking targeting biopsy (MTB) in the intraoperative localization value of colon polypectomy.

Methods

The clinical data from patients with polyp of colon discovered under colonoscopy from January 2014 to January 2016 were retrospectively analyzed. A total of 87 patients conformed to the inclusion criteria, among them, 43 received colonoscopic polypectomy one week after MTB (MTB group), while 44 underwent colonoscopic polypectomy one week after conventional biopsy (conventional group). The time consumption in colonoscopic treatment, polypectomy rate and postoperative complications between two groups were compared.

Results

The time consumed in operation in the MTB group was 25.5 (±8.6) minutes, while that in conventional group was 42.0 (±20.5) minutes, and the difference was statistically significant (P<0.01). There were a total of 86 polyps in the MTB group, among which 83 were removed, yielding the removal rate of 96.5%. There were altogether 88 polyps in the conventional group, among which 54 were removed, resulting in the removal rate of 61.4%, and the difference was statistically significant (P<0.05). three polyps in the MTB group were detached after MTB, or the wound surface became flat after gross polyp removal, and no polypectomy was required, but the marking targeting solution was clearly visible. two respective polyps in 12 cases in conventional group could not be found in colonoscopic treatment, and 10 of them had respective one polyp that could not be found again. 12 cases in MTB group suffered from abdominal pain after surgery, and no hemorrhage was seen intraoperatively and postoperatively. 10 cases in the conventional group had abdominal pain after surgery, and one case had delayed hemorrhage after surgery. The results between two groups displayed no statistical significance (P>0.05).

Conclusions

The localization value of MTB in colon polypectomy is definitely feasible, safe and effective, which can greatly shorten the time of endoscopic colon polypectomy, mitigate patient sufferings, and reduce the incidence of false negative rate of polyp. It displays favorable clinical application value and is worthy of being promoted in clinic.