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.
