Efectiveness and safety of colonoscopic polypectomy

Abstract

Introduction. Colonoscopy is now widely accepted as a gold standard for detection of pre-malignant lesions, mainly adenomatous polyps. Their removal reduces the risk for colorectal cancer in patients with adenomatous polyps. Aim. This study aimed at evaluating the efficiency and safety of colonoscopic polypectomies which were performed between 2001 and 2007. Materials and methods. A retrospective analysis of the course and results of polypectomies which were performed during 2970 colonoscopies on patients admitted to hospital with symptoms of colorectal pathology. Results and discussion. Total colonoscopy, i.e. with caecal intubation, was performed in 2602 (91%) cases. Colonoscopic polypectomies were performed during 628 (21.5%) examinations. Single polyps were found in 346 (55.1%) cases and multiple polyps in 282 (44.9%). The total number of removed polyps amounted to 901. Out of that number 690 (76.5%) were adenomas and 173 (23.5%) presented features of the so-called advanced pathology. In 26 (2.8%) cases, the detected adenomas coexisted with colorectal cancer and were removed preoperatively. Post-polypectomy bleeding occurred in 15 (2.3%) cases but only 2 patients required surgical treatment because of the inability to stop the bleeding by an endoscopic procedure. Moreover, out of 268 rectal polyps, 19 (7%) unpedunculated polyps were removed surgically (18 of them by trans-anal excision). Conclusions. The effectiveness of this method was high. Polyps were detected and removed in the course of more than 20% of colonoscopic examinations. Polypectomies were relatively complications-free, although in 2 (0.28%) cases surgical treatment was necessary to stop post-polypectomy bleeding due to the inability to stop the bleeding from the polyp stalk endoscopically. Some rectal polyps (7%) had to be removed surgically. Preoperative endoscopic clearance of large bowel polyps, coexisting with neoplastic tumours, facilitated the adjustment of the resection margin in the subsequent colorectal cancer surgery.