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Efficacy, Safety and Outcomes of ‘Inject and Cut’ Endoscopic Mucosal Resection for Large Sessile and Flat Colorectal Polyps

Background and Study Aims: The study examines the outcomes of the ‘inject and cut’ endoscopic mucosal resection (EMR), for large sessile and flat colorectal polyps. Patients and Methods: Between January 2006 and December 2008 all patients referred to our institution for EMR of large polyps were prospectively evaluated. The accuracy of lifting sign and the rate of en bloc and piecemeal resection, complications and recurrence were analyzed. Results: A total of 157 patients with 182 lesions (median size 24.7 ± 10.2 mm) were included in the study. The most frequent location was the sigmoid colon in 30.2%. Because of non-lifting sign, 5/182 lesions were referred to surgical resection and 177 (43 flat and 134 sessile) were resected, 79 (44.6%) en bloc and 98 (55.4%) piecemeal. There were 20 procedural (11.3%) and 2 late (1.1%) bleeding, 4 post-polypectomy syndrome (2.2%) and 2 perforations (1.1%). Bleeding was related to malignancy (p = 0.01). Intramucosal cancer was observed in 5 cases (2.8%) while invasive cancer was seen in 8 (4.5%). Malignancy was related to polyp size ≧30 mm (p = 0.002). Follow-up colonoscopy was performed in 147 patients with 172 EMR for a mean of 19.8 months. Recurrence was observed in 12/172 (6.9%) polyps. Conclusion: Inject and cut EMR is practical and effective with a low risk of complication and local recurrence.