Prevalence, histology, endoscopic treatment and long-term follow-up of large colonic polyps and laterally spreading tumors. The Romanian experience

• Published in: Journal of gastrointestinal and liver diseases : JGLD Vol. 17; no. 4; pp. 419 - 425
• Main Authors: Tantau, Alina I, Tantau, Marcel V, Serban, Alexandru, Zaharie, Teodor, Cruciat, Carmen, Badea, Radu, Pascu, Oliviu
• Format: Journal Article
• Language: English
• Published: Romania 01-12-2008
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma - epidemiology; Carcinoma - pathology; Carcinoma - surgery; Colon - pathology; Colon - surgery; Colonic Neoplasms - epidemiology; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; Colonic Polyps - epidemiology; Colonic Polyps - pathology; Colonic Polyps - surgery; Colonoscopy - methods; Comorbidity; Female; Follow-Up Studies; Humans; Intestinal Mucosa - pathology; Intestinal Mucosa - surgery; Male; Middle Aged; Neoplasm Invasiveness; Prevalence; Recurrence; Romania - epidemiology; Treatment Outcome; Romania
• ISSN: 1841-8724

We report the prevalence, histological aspect, endoscopic treatment and follow-up of colonic polyps of 2 cm or larger and of laterally spreading tumors (LSTs) in an eastern European country.
All consecutive colonoscopies carried out over a 1-year period (3,856) in the Endoscopy Department of the 3rd Medical Clinic Cluj-Napoca were evaluated. Fifty-two polyps and 12 LSTs of >=2cm diameter were found. Size, location and histological aspect of large colonic polyps and LSTs were assessed. Endoscopic or surgical resection was recorded. An extensive endoscopic and histological follow-up was performed.
Median size of polyps was 32mm and of LSTs 41mm. Invasive carcinoma was found in 7 polyps (20.6%) and in 4 LSTs (28.6%). Thirty-six polyps were endoscopically resected (69.2%). A complete endoscopic excision was performed in 35 polyps (98.6%). Histological complete resection was achieved in 30 polyps (83.3%). Thirteen polyps were surgically resected (25%). Eight LSTs were endoscopically resected (64.3%) using endoscopic piecemeal resection (EPMR). A complete endoscopic excision was performed in three LSTs (37.5%). Three LSTs were surgically resected (21.5%). In the polyp group, one patient presented endoscopic recurrence (16.6%) at 6 months follow-up. In the LST group, two invasive recurrences were present at 3 and 30 months of follow-up.
A complete resection can be performed in the majority of large polyps. LSTs larger than 50mm, incomplete resection and superficial invasive carcinoma were correlated with endoscopic recurrence. EPMR might be a curative method for LSTs but an accurate endoscopic diagnosis and long-term endoscopic follow-up are mandatory.