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.
