SUCCESSFUL ERADICATION OF SESSILE COLORECTAL POLYPS WITH COMBINED USE OF ENDOSCOPIC MUCOSAL RESECTION WITH ARGON PLASMA COAGULATION OF THE REMNANTS

Aims:

Sessile colorectal polyps represent sometimes a real challenge for the endoscopist. While the aim is to resect them completely by means of endoscopic mucosal resection or dissection, there are cases this approach may be unsuccessful. In these cases the use of argon plasma coagulation for eradication of the polyp remnants is a questioned approach.

Methods:

Patients who presented or were referred for sessile colorectal polyps were prospectively studied. We evaluated the size of the polyp, the number of resected pieces of the polyp, the rate of complete polypectomy and the need for argon plasma coagulation in cases of obviously remaining not excised polypoid tissue.

Results:

During a two year period we collected 56 patients with sessile adenomatous polyps. The median age of the patients was 72 years (range 24 – 87 years) and 30 were males. The mean size of the polyp was 3.2 cm (range (1.4 – 4.6). We were able to resect the polyp en bloc in 16 cases, while in the other cases the polyp was resected piecemeal in 2 to 6 pieces. Complete resection was possible in 50/56 cases. In the remaining 6 cases where complete resection was not possible, polypoid tissue was destroyed with argon plasma coagulation. Two patients had evidence of invasive malignancy in the histology and were referred for surgery. After six months only one patient had recurrence of his polyp and he was treated with a second session of endoscopic mucosal resection. In the other cases no recurrence was observed. In the six cases treated with additional argon plasma resection for incomplete mucosal resection, no recurrence.

Conclusions:

In our experience in cases of incomplete mucosal resection the destruction of remaining polypoid tissue with argon plasma coagulation leads in polyp eradication, but careful follow-up and exclusion of malignancy is required.