NEW YORK (Reuters Health) – Endoscopic resection of large colonic polyps is a safe and cost-effective alternative to surgery, according to a paper in the December issue of Gastrointestinal Endoscopy.

When a large, difficult colon lesion is found at endoscopy, the patient is usually referred for surgery. However, with a specialized clinical team trained in advanced polypectomy and endoscopic mucosal resection (EMR), such lesions may be removed and surgery avoided entirely, the authors state.

In their article, Dr. Michael J. Bourke and colleagues from Westmead Hospital in Sydney, Australia, report on 174 patients with 193 difficult polyps who were treated by their tertiary referral colonic mucosal resection and polypectomy service from August 2006 to April 2008.

Except for 7 pedunculated polyps (median size, 40 mm), all were spreading laterally, with a median size of 30 mm.

EMR allowed full excision of 173 sessile lesions and all 7 pedunculated lesions. EMR was successful in 5 of 6 lesions in which invasive adenocarcinoma was identified.

Eleven patients with suspected invasive carcinoma were referred directly for surgery, without an endoscopic attempt.

No perforations occurred; a total of “20 bed days” in the hospital were used for other endoscopic complications.

The authors calculate that their endoscopy team helped 90% of these patients avoid surgery. Moreover, after excluding subjects treated surgically for invasive cancer, the procedure success rate was 95%.

By referring patients with difficult lesions for endoscopy rather than directly to surgery, the authors estimate that US$6990 was saved per patient and US$1,216,231 was saved total.

A tertiary referral colonic mucosal resection and polypectomy service “results in major cost savings and avoids the protracted recovery and potential complications of colonic surgery in the majority of patients,” the researchers state. “This type of clinical pathway should be developed to enhance patient outcomes and reduce healthcare costs.”

Reference:
Gastrointest Endosc 2009;70:1128-1136.