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Treatment of large and giant colorectal polyps in the real world

Treatment of large and giant colorectal polyps in the real world. Stéphanie HUSSON, Guy VENTRE, Frédéric VAGNE, Jean François VIES, Marjorie MUSSO, Jean Louis COLSON, Jacques PICOT, Jean Marc BOYAVAL, Daniel SONDAG, François KHACHOYAN, Isabelle GENDRE, Philippe PERRIN, Bernard DENIS

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Treatment of large and giant colorectal polyps in the real world

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  1. Treatment of large and giant colorectal polyps in the real world Stéphanie HUSSON, Guy VENTRE, Frédéric VAGNE, Jean François VIES, Marjorie MUSSO, Jean Louis COLSON, Jacques PICOT, Jean Marc BOYAVAL, Daniel SONDAG, François KHACHOYAN, Isabelle GENDRE, Philippe PERRIN, Bernard DENIS Association pour le dépistage du cancer colorectal dans le Haut-Rhin (ADECA 68), Colmar, France

  2. background • large polyps ≥ 20 mm / giant ≥ 30 mm • endoscopic resection effective and safe Walsh RM 1992, Dell’Abate P 2001, Brooker JC 2002, Seitz U 2003, Conio M 2004, Katsinelos P 2006 • success rates ~1OO% Binmoeller KF 1996, Kanamori T 1996, Iishi H 2000, Stergiou N 2002, Doniec JM 2003, Bories E 2006, • how about the real world?

  3. aim to assess the success rate of endoscopic resection of large colorectal polyps in a population-based setting

  4. methods • population-based CRC screening program with guaiac based FOBT • 23 pilot areas • Haut-Rhin: 190 000 residents aged 50-74 y (Denis B et al. Gut 2007 in press)

  5. methods • retrospective study • all large polyps detected • CRC screening program in the Haut-Rhin • 3 year period (sept. 2003 - sept. 2006)

  6. results • 34 endoscopists (21 private practice) • 2968 colonoscopic procedures • 325 large polyps in 279 people (82 women) prevalence = 9.4%

  7. results – polyps characteristics

  8. results – polyps characteristics

  9. results – polyps characteristics

  10. results – polyps characteristics

  11. results – polyps characteristics

  12. results – polyps characteristics

  13. results – polyps characteristics

  14. results – endoscopic resection • 247 polyps (76%) in 220 people • resection during • single session: 76.8% • 2nd procedure other expert endoscopist: 4.6% • En bloc resection: 67.2% • EMR: 8.6% • 2 bleeding / endoscopic treatment

  15. results – surgical resection • 78 polyps (24%) in 61 people • reasons • endoscopic resection failure: 44.0% • polyposis: 9.3% • malignant polyp: 46.7% • no complication

  16. endoscopic resection rate P<0.001 P<0.001 20–29 mm >30 mm pedunc. sessile / flat

  17. endoscopic resection rate P=0.02 P<0.01 P<0.001

  18. endoscopic resection rate P<0.001

  19. conclusions (1) • largest series • 1st in a population-based setting • in the real world • 1 / 5 patients with a benign large polyp is operated on • 2 / 5 with a benign giant polyp

  20. conclusions (2) • referral to surgery related to • sessile or flat shape • size, • proximal or rectal location, • malignancy and • lack of referral to an expert endoscopist • EMR performed by a minority (41.2%) • referral to an expert is rare (4.6%)

  21. future • need for • teaching (spreading) endoscopic techniques for the management of large polyps • promoting referral of difficult large polyps to expert endoscopists to avoid unnecessary surgery

  22. all the 34 endoscopists practicing in the Haut-Rhin acknowledgements

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