Piecemeal Versus En Bloc Resection of Large Rectal Adenomas

Launched by UNIVERSITÄTSKLINIKUM HAMBURG-EPPENDORF · Sep 10, 2014

Keywords

ClinConnect Summary

In 20 to 35% of colonoscopies due to symptoms or for prevention polyps, so-called adenoma, are found. Currently, colonoscopy is the best way to detect bowel tumors and polyps, since these can be biopsied and removed in one working process. If the size of adenoma is larger than 2 cm, resections are usually done in a hospital setting. Foremost for flat adenoma, the resection by snares piece by piece, the so-called piecemeal polypectomy, or piecemeal endoscopic mucosal resection (EMR), is state of the art. Resection will usually follow a submucosal saline injection (saline assisted polypectomy...

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • patients with large non pedunculated colorectal adenomas designated for endoscopic resection up to 15 cm ab ano, length 2 cm to 5 cm, maximum hemicircumferential
• • age \> 18 years
• • signed Informed Consent
• Exclusion Criteria:
• • adenomas smaller or larger than described above
• • more than one large rectal adenoma
• • adenomas with known or suspected carcinoma, proven by previous biopsies
• • adenomas with known or suspected carcinoma that do not seem to be resectable by endoscopy, e.g. ulcers, suspected infiltration of submucosa after endoscopic or ultrasound diagnostics
• • patients with chronic inflammatory bowel diseases
• • severe general disease, including metastasising carcinomas
• • coagulation abnormalities or anticoagulant drug use which make resection therapy impossible
• • bad general state of health (American Society of Anesthesiologists Classification (ASA) IV or more)
• • pregnancy and lactation
• • recurrence or leftover dysplasia after extended endoscopic or surgical therapy (transanal endoscopic microsurgery (TEM))