Resection of large, broad-based pedunculated and semi-pedunculated colorectal polyps using a scissor-type endoscopic submucosal dissection knife.

Background and study aims: Endoscopic resection of large, broad-based pedunculated and semi-pedunculated polyps can be technically difficult. Conventional snare resection risks immediate bleeding and piecemeal excision. We evaluated the safety and efficacy of a scissor-type endoscopic submucosal dissection (ST-ESD) knife for these lesions. Patients and methods: A single-center retrospective study was conducted of all patients who underwent ST-ESD resection of pedunculated or semi-pedunculated polyps with head size ≧ 20 mm and stalk width ≧ 10 mm. Primary outcomes were en bloc resection, intraprocedural and delayed bleeding, and perforation. Secondary outcomes were R0 resection and recurrence at first follow-up. Results: Fifty-eight resections were identified (75.6% male; median age 60 years). Median head size was 30 mm (range 20-70) with median stalk width 15 mm (range 10-50). Of them, 74.1% were in the sigmoid colon. Successful resection was achieved in 52 of 58 (89.7%); 44 (75.9%) by ST-ESD alone and eight (13.8%) snare-assisted. Six (10.3%) were abandoned; five due to visible muscle retraction and one dense stalk fibrosis. All successful resections were en bloc with R0 in 52 of 52 (100%). Minor intraprocedural bleeding occurred in nine of 58 (15.5%) and was controlled endoscopically. Forty-seven of 52 defects (90.4%) were closed prophylactically with endoscopic clips. There were no incidences of delayed bleeding or perforation. Histopathology was benign in 51 of 52 (98.1%). One adenocarcinoma was treated surgically for high-risk features. Endoscopic follow-up was available in 41 of 52 (78.8%) with no recurrence seen. Zero of six abandoned cases referred for surgery contained evidence of malignancy in the surgical specimen. Conclusions: ST-ESD is safe and effective for resection of large, broad-based pedunculated and semi-pedunculated colorectal polyps.