Long-Term Follow-Up of Large Flat Colorectal Tumors Resected Endoscopically

Background and Study Aim: When a large flat colorectal tumor is excised by piecemeal endoscopic resection, it is not possible to obtain suitable specimens for histopathological examination to assess whether the resection has been complete. We prospectively analysed follow-up colonoscopy examinations of endoscopic polypectomy resection sites for residual lesions.
Patients and Methods: A total of 24 patients with large flat colorectal tumors were treated using an endoscopic submucosal saline injection technique. The resection site was prospectively examined for residual lesions using a magnifying colonoscope, at 3, 6, 12 and 24 months postoperatively.
Results: None of the 5 patients who underwent en bloc resection exhibited residual lesions postoperatively. Of the 19 patients who underwent piecemeal resection, one died of an asthma attack and 18 were followed up. Residual lesions were detected in four of these 18 patients (three adenomas and one cancer), which were resected endoscopically. When the tumor was resected endoscopically en bloc and was judged histologically to be completely resected, residual lesions were not detected at follow-up. However, residual lesions were detected in 22.2 % of patients 3 months after initial resection when polyps were resected piecemeal. After treatment, residual lesions were detected in two patients (11.1 %) at 24 months.
Conclusion: After piecemeal endoscopic resection for large flat colorectal tumors, it is necessary to follow-up and remove residual lesions endoscopically every 3 months until they all are removed.

References

• 1 Binmoeller K F, Bohnacker S, Seifert R. et al . Endoscopic snare excision of ‘giant’ colorectal polyps.  Gastrointest Endosc. 1996;  43 183-188
• 2 Walsh R M, Ackroyd F W, Shellito P C. Endoscopic resection of large sessile colorectal polyps.  Gastrointest Endosc. 1992;  38 303-309
• 3 Yoshikane H, Hidano H, Sakakibara A. et al . Endoscopic resection of laterally spreading tumours of the large intestine using a distal attachment.  Endoscopy. 1999;  31 426-430
• 4 Kanamori T, Itoh M, Yokoyama Y. et al . Injection-incision-assisted snare resection of large sessile colorectal polyps.  Gastrointest Endosc. 1996;  43 189-195
• 5 Zlatanic J, Waye J D, Kim P S. et al . Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy.  Gastrointest Endosc. 1999;  49 731-735
• 6 Kronborg 0. Colon polyps and cancer.  Endoscopy. 2002;  34 69-72
• 7 Tanaka S, Haruma K, Oka S. et al . Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm.  Gastrointest Endosc. 2001;  54 62-66
• 8 Kudo S, Tamura S, Nakajima S. et al . Depressed type of colorectal cancer.  Endoscopy. 1995;  27 54-57
• 9 Strekalovsky V P. Results of endoscopic removal of villous tumors of the colon.  Endoscopy. 1983;  15 49-52
• 10 Saito Y, Fujii T, Kondo H. et al . Endoscopic treatment for laterally spreading tumors in the colon.  Endoscopy. 2001;  33 682-686
• 11 Karita M, Tada M, Okita K. et al . Endoscopic therapy for early colon cancer: the strip biopsy resection technique.  Gastrointest Endosc. 1991;  37 128-132
• 12 Jass J P, Sobin L K. WHO Histological typing of intestinal tumors. Berlin; Springer 1989
• 13 Kudo S, Tamura S, Nakima T. et al . Diagnosis of colorectal tumorous lesions by magnifying endoscopy.  Gastrointest Endosc. 1996;  44 8-14
• 14 Tada M, Misaki F, Kawai K. A new approach to the observation of minute changes of the colonic mucosa, by means of magnifying colonoscope, type CF-MB-M (Olympus).  Gastrointest Endosc. 1978;  24 146-147
• 15 Nishizawa M, Okada T, Sato F. et al . A clinicopathological study of minute polypoid lesions of the colon based on magnifying fiber-colonoscopy and dissecting microscopy.  Endoscopy. 1980;  12 124-129
• 16 Axelrad A M, Fleischer D E, Geller A J. et al . High-resolution chromoendoscopy for the diagnosis of diminutive colon polyps: implications for colon cancer screening.  Gastroenterology. 1996;  110 1253-1258
• 17 Kato S, Fujii T, Koba I. et al . Assessment of colorectal lesions using magnifying colonoscopy and mucosal dye spraying: can significant lesions be distinguished?.  Endoscopy. 2001;  33 306-310
• 18 Kiesslich R, von Bergh M, Hahn M. et al . Chromoendoscopy with indigocarmine improves the detection of adenomatous and nonadenomatous lesions in the colon.  Endoscopy. 2001;  33 1001-1006
• 19 Mukai M, Iwase H, Himeno S. et al . A novel approach to endoscopic colorectal mucosal resection using a three-channel outer tube and multiple forceps: an experimental assessment.  Endoscopy. 2001;  33 253-256