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Endoscopic management of giant colonic polyps: a retrospective Italian study
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Paolo Quitadamo, Sara Isoldi, Germana De Nucci, Giulia Muzi, Flora Caruso
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Clin Endosc 2024;57(4):501-507. Published online June 5, 2024
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DOI: https://doi.org/10.5946/ce.2023.229
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 Graphical Abstract
 Abstract
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 - Background
/Aims: Polyps greater than 30 mm are classified as “giants”. Their endoscopic removal represents a technical challenge. The choice of the endoscopic removal technique is important because it provides a resection sample for precise histopathological staging. This is pivotal for diagnostic, prognostic, and management purposes.
Methods
From a retrospective analysis, we obtained a sample of 38 giant polyps. Eighteen polypectomies were performed using the epinephrine volume reduction (EVR) method, nine polypectomies utilized endo-looping or clipping methods, and 11 patients underwent surgery.
Results
We obtained en bloc resection with the EVR method in all cases; histology confirmed the correct indication for endoscopic resection in all cases. Moreover, no early or delayed complications were observed, and no patient required hospitalization. Using endo-looping or clipping methods, we observed advanced histology in 1/9 (11.1%) cases, while another patient (1/9, 11.1%) had delayed bleeding. Among patients who underwent surgery, 5/11 (45.5%) were deemed overtreated and three had post-surgical complications.
Conclusions
We propose EVR as an alternative technique for giant polyp resection due to its safety, effectiveness, cost-efficiency, and the advantage of avoiding the need to postpone polypectomy to a later time. Further prospective studies might help improve this experience and enhance the technique.
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Citations
Citations to this article as recorded by  - Endoscopic approaches for the management of giant colonic polyps
Yunho Jung
Clinical Endoscopy.2024; 57(4): 468. CrossRef
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