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Endoscopic resection reduces morbidity when compared to surgery in veterans with large and complex colorectal polyps

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Abstract

Introduction

Data supporting endoscopic resection (ER) over surgical resection (SR) for large and complex polyps come from high-volume centers. The aim of this study was to determine whether these favorable outcomes can be replicated among endoscopists at tertiary Veterans Affairs Medical Centers (VAMCs) who perform 25 to 30 ER cases a year.

Methods

Patients with adenomatous polyps or intra-mucosal cancers ≥ 2 cm in size who underwent ER or SR were identified from prospectively maintained databases at the 2 tertiary VAMCs in Veterans Integrated Service Network 6 (VISN6). The primary outcome was the rate of serious complications in the ER and SR groups.

Results

310 ER and 81 SR patients met the inclusion criteria. ER was successful in 97% of all polyps, and 93% of polyps ≥ 4 cm. The rate of serious complications was significantly lower with ER compared to SR (0.6% vs. 22%, p = 0.00001). These findings persisted even after limiting the analysis to polyps ≥ 4 cm and after propensity score matching. If all ER patients had instead undergone laparoscopic surgery, the estimated risk of a serious complication was still higher than ER for all patients (8% vs. 0.6%, p < 0.0001) but not significantly higher for polyps ≥ 4 cm (8% vs 2%, p = 0.17).

Conclusions

This study documents high success rates for ER in veterans with colorectal polyps ≥ 2 cm and ≥ 4 cm. When compared to a historical cohort of surgical patients, a strategy of attempting ER first reduced morbidity. A randomized trial is warranted to compare ER to laparoscopic surgery for polyps ≥ 4 cm.

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Authors and Affiliations

  1. Department of Internal Medicine, Virginia Commonwealth University Health Center, Richmond, USA

    Milan Patel

  2. Division of Gastroenterology, Durham VA Medical Center, Durham, USA

    Mahfuzul Haque

  3. Division of Gastroenterology and Hepatology, Duke University Medical Center, Durham, USA

    Mahfuzul Haque

  4. Division of Gastroenterology, Kansas City VA Medical Center, Kansas City, USA

    Divyanshoo Kohli

  5. Division of Gastroenterology, University of Kansas Medical Center, Kansas City, USA

    Divyanshoo Kohli

  6. Division of Gastroenterology, Hunter Holmes McGuire VA Medical Center, Richmond, USA

    Pritesh Mutha, Alvin Zfass & Tilak Shah

  7. Division of Gastroenterology and Hepatology, Department of Medicine, Virginia Commonwealth University Health Center, Richmond, USA

    Pritesh Mutha, Syed A. Shah, Leopoldo Fernandez, Alvin Zfass & Tilak Shah

  8. Department of Surgery, Hunter Holmes McGuire VA Medical Center, Richmond, USA

    Syed A. Shah & Leopoldo Fernandez

Authors
  1. Milan Patel
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  2. Mahfuzul Haque
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  8. Tilak Shah
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Contributions

MP collected the data, performed the literature review and wrote the manuscript. MP is the article guarantor. MH and TS performed the endoscopic procedures. TS, MH, DK, PM, SS, LF and AZ edited the manuscript.

Corresponding author

Correspondence to Tilak Shah.

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Disclosures

Milan Patel, Mahfuzul Haque, Divyanshoo Kohli, Pritesh Mutha, Syed A. Shah, Leopoldo Fernandez, Alvin Zfass, Tilak Shah have no conflicts of interest or financial ties to disclose.

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Patel, M., Haque, M., Kohli, D. et al. Endoscopic resection reduces morbidity when compared to surgery in veterans with large and complex colorectal polyps. Surg Endosc 35, 1164–1170 (2021). https://doi.org/10.1007/s00464-020-07482-y

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  • DOI: https://doi.org/10.1007/s00464-020-07482-y

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