ENDOSCOPIC TREATMENT OF GIANT COLONIC ADENOMAS. EXPERIENCE OF A THIRD LEVEL HOSPITAL

Aims:

The size of the lesions has traditionally been considered a crucial factor to indicate an endoscopic treatment. However, there is evidence that this factor is not a limitation when practicing an endoscopic resection, with guarantees of cure comparable to surgical treatment. The aim of this work is to evaluate the efficacy of endoscopic mucosal resection as treatment of colorectal lesions ≥4 cm.

Methods:

Giant colonic adenoma was defined arbitrarily as a lesion ≥4 cm. Using the database of the unit, a retrospective and descriptive analysis of the therapeutic results of endoscopic resection was carried out in this subgroup of lesions.

Results:

A total of 42 lesions ≥4 cm (59.17 mm 40 – 120) were treated. Of these, 50% were located in the left colon and 16.7% had a mixed pattern. In 50% of the cases, carcinoma was detected in the specimen with > Sm1 in 8/42 (19%). Therapeutic success was achieved in 81%. Complete resection was achieved in 77.8%, requiring adjuvant treatment with APC in the rest. Complications have been recorded in 9/42 (21.4%): 7/42 (16.6%) presented hemorrhage (3 during the procedure, 3 in the 7 following days and only 1 case of delayed bleeding> 7 days) and in 3/42 (7.1%) abdominal pain appeared. All of them were resolved conservatively. In addition, early recurrence (< 1 year) was observed in 23.5%, with no cases of late recurrence among those recorded to date.

Conclusions:

The endoscopic treatment of lesions larger than 4 cm is a therapeutic option with acceptable results. However, a bigger size implies more therapeutic failure and complications related to the procedure that make it less effective than what is described with the standard technique for < 4 cm lesions.