| Theme |
Management of large colorectal polyp --Indication and technique of endoscopic treatment |
| Title |
The management of colorectal polyps larger than 2cm |
| Author |
Fumio Konishi |
Department of Surgery, Omiya Medical Center,Jichi Medical School |
| Author |
Kazutomo Togashi |
Department of Surgery, Jichi Medical School |
| Author |
Tooru Hoshino |
Department of Surgery, Jichi Medical School |
| Author |
Masaki Kanzaki |
Department of Surgery, Jichi Medical School |
| [ Summary ] |
The management of colorectal polyps larger than 2cm is controversial, because of the higher incidence of invasive carcinoma and also because of the technical difficulties of removing large polyps through endoscopic procedures. In our series of polyps, larger than 2cm the incidence of invasive carcinoma was 27% (42/155). There are two important factors that determine the method of treatment for polyps larger than 2cm. First, assessment of whether there is a massive invasion in the submucosa should be done by meticulous observation under colonoscopy, magnifying colonoscopy and endoscopic ultrasonography. When there are definite findings of massive invasion in the submucosa with these diagnostic modalities, either laparoscopic colectomy or open colectomy is to be performed. Secondly, the technical feasibility of endoscopic resection is an important factor. When the findings of the above investigation show no invasion in the submucosa, colonoscopic resection should be considered. However, when the lesion is larger than 3-4cm or when it is difficult to have a stable colonoscopic observation of the entire lesion, colonoscopic resection is technically difficult, and surgical resection is indicated. As a procedure for bowel resection, laparoscopic colectomy is preferable to open colectomy because of its minimal invasiveness. |