Treatment of large and giant colorectal polyps in the real world Stéphanie HUSSON, Guy VENTRE,...
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Transcript of Treatment of large and giant colorectal polyps in the real world Stéphanie HUSSON, Guy VENTRE,...
Treatment of large and giant colorectal polyps in the real
world
Stéphanie HUSSON, Guy VENTRE, Frédéric VAGNE, Jean François VIES, Marjorie MUSSO, Jean Louis COLSON, Jacques PICOT, Jean Marc BOYAVAL, Daniel SONDAG, François KHACHOYAN, Isabelle
GENDRE, Philippe PERRIN, Bernard DENIS
Association pour le dépistage du cancer colorectal dans le Haut-Rhin (ADECA 68), Colmar, France
B. Denis - DDW 2007 – Washington DC
background
large polyps ≥ 20 mm / giant ≥ 30 mm
endoscopic resection effective and safe Walsh RM 1992, Dell’Abate P 2001, Brooker JC 2002, Seitz
U 2003, Conio M 2004, Katsinelos P 2006
success rates ~ 1OO% Binmoeller KF 1996, Kanamori T 1996, Iishi H 2000,
Stergiou N 2002, Doniec JM 2003, Bories E 2006,
how about the real world?
B. Denis - DDW 2007 – Washington DC
aim
to assess the success rate of endoscopic resection of
large colorectal polyps in a population-based setting
B. Denis - DDW 2007 – Washington DC
methods
population-based CRC screening program with guaiac based FOBT
23 pilot areas
Haut-Rhin: 190 000 residents aged 50-74 y
(Denis B et al. Gut 2007 in press)
B. Denis - DDW 2007 – Washington DC
methods
retrospective study all large polyps detected CRC screening program in the Haut-
Rhin
3 year period (sept. 2003 - sept. 2006)
B. Denis - DDW 2007 – Washington DC
results
34 endoscopists (21 private practice)
2968 colonoscopic procedures
325 large polyps in 279 people (82
women)
prevalence = 9.4%
B. Denis - DDW 2007 – Washington DC
results – polyps characteristics
n (%)
size20 – 29 mm 215 (66.2)
≥ 30 mm 110 (33.8)
B. Denis - DDW 2007 – Washington DC
results – polyps characteristics
n (%)
shape
pedunculated 226 (69,5)
sessile 79 (24,3)
flat 11 (3,4)
B. Denis - DDW 2007 – Washington DC
results – polyps characteristics
n (%)
shape
pedunculated 226 (69,5)
sessile 79 (24,3)
flat 11 (3,4)
B. Denis - DDW 2007 – Washington DC
results – polyps characteristics
n (%)
location
rectum 48 (14,8)
distal colon 232 (71,4)
proximal colon 45 (13,8)
B. Denis - DDW 2007 – Washington DC
results – polyps characteristics
n (%)
location
rectum 48 (14,8)
distal colon 232 (71,4)
proximal colon 45 (13,8)
B. Denis - DDW 2007 – Washington DC
results – polyps characteristics
n (%)
type
tubular 119 (37,0)
tubulo-villous 174 (54,0)
villous 27 (8,4)
serrated 1 (0,3)
hyperplastic 1 (0,3)
B. Denis - DDW 2007 – Washington DC
results – polyps characteristics
n (%)
dysplasia
high-grade 217 (66,8)
T1 carcinoma 31 (9,5)
B. Denis - DDW 2007 – Washington DC
results – endoscopic resection
247 polyps (76%) in 220 people
resection during single session: 76.8%
2nd procedure other expert endoscopist: 4.6%
En bloc resection: 67.2%
EMR: 8.6%
2 bleeding / endoscopic treatment
B. Denis - DDW 2007 – Washington DC
results – surgical resection
78 polyps (24%) in 61 people
reasons endoscopic resection failure: 44.0%
polyposis: 9.3%
malignant polyp: 46.7%
no complication
B. Denis - DDW 2007 – Washington DC
endoscopic resection rate
85,1% 86,3%
52,2%55,5%
P<0.001 P<0.001
20–29 mm >30 mm pedunc. sessile / flat
B. Denis - DDW 2007 – Washington DC
endoscopic resection rate
P=0.02 P<0.001
64,6%
80,2%
60,0%
rectum distal colon proximal
colon
80,3%
25,8%
benign cancer
P<0.01
B. Denis - DDW 2007 – Washington DC
endoscopic resection rate
P<0.001
86,4%
68,6%
expert endoscopist non expert
B. Denis - DDW 2007 – Washington DC
conclusions (1)
largest series
1st in a population-based setting
in the real world 1 / 5 patients with a benign large polyp is operated on 2 / 5 with a benign giant polyp
B. Denis - DDW 2007 – Washington DC
conclusions (2)
referral to surgery related to sessile or flat shape size, proximal or rectal location, malignancy and lack of referral to an expert endoscopist
EMR performed by a minority (41.2%)
referral to an expert is rare (4.6%)
B. Denis - DDW 2007 – Washington DC
future
need for
teaching (spreading) endoscopic techniques
for the management of large polyps
promoting referral of difficult large polyps to expert endoscopists to avoid unnecessary surgery
B. Denis - DDW 2007 – Washington DC
acknowledgements
all the 34 endoscopists practicing in the Haut-Rhin