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Study examines repeat colonoscopy in patients with polyps referred for surgery without biopsy-proven cancer
Date:1/28/2014

have definite features of deeply invasive cancer (converging folds, firm consistency with a surface pit pattern suggestive of invasion, nonlifting not because of previous endoscopic interventions). All patients were evaluated for procedural adverse events with a phone call or clinic visit at least 10 days after the procedure.

Results

There were 38 lesions in 36 patients; 71 percent of the lesions referred for surgery were noncancerous polyps and were treatable endoscopically. In 26 percent of cases, previous removal was attempted by the referring physician but was unsuccessful. Endoscopic treatment was performed as an outpatient procedure without serious adverse events, and hospital admission for overnight observation was necessary in only six percent of patients. The researchers noted that the major limitation of endoscopic treatment was a high local recurrence rate of 50 percent, although in keeping with results from other studies, recurrences were successfully treated on follow-up colonoscopy. The favorable results in this study suggest that most lesions currently referred for surgery are amenable to endoscopic treatment.

According to the researchers, the decision of whether to refer a patient to an interventional colonoscopy center versus surgical resection may depend on multiple factors, including whether the endoscopist who performed the initial colonoscopy believes that reasonable endoscopic methods to remove the polyp have been exhausted. However, endoscopist inexperience or an unwillingness to tackle technically challenging lesions because of time constraints or perceived risk may also contribute to the decision.

In an accompanying editorial, Alan Moss, MBBS (Hons), MD, FRACP, Department of Endoscopic Services, Western Health, Melbourne, Australia, states "The pathway for patients between EMR and surgery is a 2-way street. EMR proceduralists should have the support of that center's colorectal surgical team, because in
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Contact: Anne Brownsey
abrownsey@asge.org
630-570-5635
American Society for Gastrointestinal Endoscopy
Source:Eurekalert

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