Sahil Sharma, BSc1, Akhil Sharma, BSc2, Vladislav Khokhotva, MD1
1Western University, Windsor, ON, Canada; 2Michigan State University, College of Osteopathic Medicine, Windsor, ON, Canada
Introduction: Piecemeal polypectomy refers to the removal of large sessile colonic polyps by means of multiple snarings and is commonly performed after submucosal injection of a liquid, typically normal saline. Some reports suggest submucosal injection may not be benign, due to concerns of needle tracking of neoplastic cells, and difficulty in removal of recurrences due to scarring after injection. There is a paucity of recent literature describing polypectomy without submucosal injection. Historically, non-elevated piecemeal polypectomy has been criticized for concerns regarding bleeding and perforation. The purpose of this study was to describe a retrospective review of colonic polyps removed using non-elevated piecemeal polypectomy and associated outcomes.
Methods: An outpatient endoscopy center database was searched for patients who had large (≥3.0) sessile polyps excised using non-elevated piecemeal polypectomy technique between December 2012 and December 2018. All polyps with invasive cancer were excluded (n=3). Chart review was carried out to extract demographic data, outcomes and adverse events. Details of all subsequent colonoscopies, including recurrences, residual tissue, or need for surgery were recorded.
Results: During the study period, 73 patients underwent 78 non-elevated piecemeal polypectomies for polyps ≥3 cm. There were 27 (37%) female patients and 46 (63%) male patients. Most common polyp sizes were between 3.5 cm to 3.9 cm (48.7%) or ≥4 cm (52.6%). Tubulovillous adenoma was the most frequent histological subtype (48.7%). Most polypectomies occurred in the right colon (54.4%). There were zero events of perforation. Ten (12.6%) patients had intraprocedural bleeding controlled endoscopically. Four patients (5.1%) had post-procedural bleeding, 3 required colonoscopy and clip hemostasis. There were 10 recurrences (12.8%), nine were found at the first endoscopic follow up and controlled by means of non-elevated hot snare polypectomy. One patient had a persistent recurrence and required subsequent surgical management for an adenocarcinoma.
Discussion: Non-elevated piecemeal polypectomy with hot snare is a safe and effective technique for the removal of large sessile (≥3cm) colonic polyps. Perforation and bleeding are uncommon. Recurrences are easily controlled by additional hot snare resection.
Citation: Sahil Sharma, BSc; Akhil Sharma, BSc; Vladislav Khokhotva, MD. P1276 - EFFICACY AND SAFETY OF NON-ELEVATED PIECEMEAL POLYPECTOMY USING HOT SNARE. Program No. P1276. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.