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Tip-in endoscopic mucosal resection for large colorectal sessile polyps

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Abstract

Background

Tip-in endoscopic mucosal resection (EMR) is a modified EMR technique using which en bloc resection of large colorectal sessile polyps can be performed; however, its usefulness for colorectal sessile polyps of > 20 mm has not been reported. This study examined treatment outcomes of tip-in and conventional EMR for large colorectal sessile polyps of ≥ 20 mm.

Methods

This was a retrospective case–control study conducted at a single tertiary center in Japan. Subjects included those with large colorectal sessile polyps of ≥ 20 mm, excluding pedunculated-type polyps, who underwent endoscopic resection between January 2010 and January 2019. The primary outcome was endoscopic treatment outcomes when using tip-in and conventional EMR, and the secondary outcome was the local recurrence rate after endoscopic treatment.

Results

Forty-three colorectal lesions were treated using tip-in EMR and 83 using conventional EMR. Tip-in EMR had a significantly higher en bloc resection rate (90.7% vs. 69.8.%), and significantly shorter treatment duration (6.64 ± 0.64 min vs. 10.47 ± 0.81 min) than conventional EMR. However, for lesions > 30 mm, en bloc resection rate was 50.0% and 52.6% for tip-in and conventional EMR, respectively, indicating no significant difference. Perforation rates with tip-in and conventional EMR were 4.6% and 3.6%, respectively, indicating no significant difference. Local recurrence was examined in 80 cases who were followed up for > 6 months after endoscopic resection; recurrence rate was 0% and 7.0% in tip-in and conventional EMR cases, respectively, without significance difference.

Conclusions

Tip-in EMR showed high en-block resection rate, particularly in polyps of < 30 mm, and no residual tumor was found. This technique is a potential endoscopic treatment alternative for large colorectal sessile polyps of ≥ 20 mm.

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Acknowledgements

We thank Enago for valuable comments and review of the English manuscript.

Funding

This study did not receive any funding.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan

    Yoshinori Sato, Shun-ichiro Ozawa, Hiroshi Yasuda, Masaki Kato, Hirofumi Kiyokawa, Masaki Yamashita, Yasumasa Matsuo, Hiroyuki Yamamoto & Fumio Itoh

  2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Yokohama City Seibu Hospital, Yashi-cho 1197-1, Asahi-ku, Yokohama-shi, Kanagawa, 241-0811, Japan

    Shun-ichiro Ozawa

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  1. Yoshinori Sato
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Correspondence to Yoshinori Sato.

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Drs. Yoshinori Sato, Shun-ichiro Ozawa, Hiroshi Yasuda, Masaki Kato, Hirofumi Kiyokawa, Masaki Yamashita, Yasumasa Matsuo, Hiroyuki Yamamoto, and Fumio Itoh have no conflicts of interest or financial ties to disclose.

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Sato, Y., Ozawa, Si., Yasuda, H. et al. Tip-in endoscopic mucosal resection for large colorectal sessile polyps. Surg Endosc 35, 1820–1826 (2021). https://doi.org/10.1007/s00464-020-07581-w

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