Management of giant colorectal polyps (≥3 cm) by endoscopic submucosal dissection (ESD) versus surgery: a propensity score–based analysis

Abstract

Aim

Giant colorectal polyps (≥3 cm) can be managed by endoscopic excision or surgical resection. There has been a shift to endoscopic submucosal dissection (ESD) for the treatment of such lesions as the expertise in advanced therapeutic endoscopy develops. This study aims to compare the outcome and safety profile of ESD against surgical resection for patients with giant colorectal polyps.

Methods

We performed a retrospective review on patients with giant colorectal polyps removed by either ESD or surgery over a 10-year period (from May 2010 to September 2020) in a regional hospital in Hong Kong. Propensity score matching was performed based on patient demographics and polyp characteristics. Outcomes including polyp histology, complication rates, length of hospital stay, and re-admission rates were analysed.

Results

Fifty-one patients (ESD group: 34, surgery group: 17) were included in the analysis. The mean polyp diameter was 3.35 cm (ESD group) and 3.53 cm (surgery group). The median procedure time was comparable (160 vs 167 min; P = .251) and the most common polyp histological type was tubulovillous adenoma (44.1% vs 47.1%; P = .130) for both groups. A shorter median length of stay (1 day vs 6 days; P = .028) and lower re-admission rate (0% vs 5.9%; P < .001) were observed in the ESD group, whereas a higher major complication rate (Clavien–Dindo classification grade IIIa or above; 2.9% vs 11.7%; P = .013) was observed in the surgery group.

Conclusions

ESD is a safe and effective treatment for giant colonic polyps with ESD size ≥3 cm. It has the advantage of lower complication rates, shorter length of hospital stays, and lower re-admission rates compared with surgical resection.