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Safe and Effective Endoscopic Resection of Massive Colorectal Adenomas ≥8 cm in a Tertiary Referral Center

Emmanuel, Andrew, M.S.; Gulati, Shraddha, M.B.B.S; Burt, Margaret, R.N.; Hayee, Bu’Hussain, Ph.D.; Haji, Amyn, M.D.

Diseases of the Colon & Rectum: August 2018 - Volume 61 - Issue 8 - p 955–963
doi: 10.1097/DCR.0000000000001144
Original Contributions: Endoscopy
Denotes Associated Video Abstract
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BACKGROUND: Endoscopic resection of large colorectal lesions is well reported and is the first line of treatment for all noninvasive colorectal neoplasms in many centers, but little is known about the outcomes of endoscopic resection of truly massive colorectal lesions ≥8 cm.

OBJECTIVE: We report on the outcomes of endoscopic resection for massive (≥8 cm) colorectal adenomas and compare the outcomes with resection of large (2.0–7.9 cm) lesions.

DESIGN: This was a retrospective study.

SETTINGS: The study was conducted in a tertiary referral unit for interventional endoscopy.

PATIENTS: A total of 435 endoscopic resections of large colorectal polyps (≥2 cm) were included, of which 96 were ≥8 cm.

MAIN OUTCOME MEASURES: Outcomes included initial successful resection, complications, recurrence, surgery, and hospital admission.

RESULTS: Endoscopic resection was successful for 91 of 96 massive lesions (≥8 cm). Mean size was 10.1 cm (range, 8–16 cm). A total of 75% had previous attempts at resection or heavy manipulation before referral. Thirty two were resected using endoscopic submucosal dissection or hybrid endoscopic submucosal dissection and the rest using piecemeal endoscopic mucosal resection. No patients required surgery for a perforation. Five patients had postprocedural bleeding. There were 25 recurrences: 2 were treated with transanal endoscopic microsurgery, 2 with right hemicolectomy, and the rest with endoscopic resection. Compared with patients with large lesions, more patients with massive adenomas had complications (19.8% versus 3.3%), required admission (39.6% versus 11.0%), developed recurrence (30.8% versus 9.9%), or required surgery for recurrence (5.0% versus 0.8%).

LIMITATIONS: This was a retrospective study.

CONCLUSIONS: Endoscopic resection of massive colorectal adenomas ≥8 cm is achievable with few significant complications, and the majority of patients avoid surgery. Systematic assessment is required to appropriately select patients for endoscopic resection, which should be performed in specialist units. See Video Abstract at

King’s Institute of Therapeutic Endoscopy, King’s College Hospital, National Health Service Foundation Trust, London, United Kingdom

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (

Funding/Support: None reported.

Financial Disclosure: None reported.

Poster presentation at Digestive Diseases Week, San Diego, CA, May 21 to 24, 2016.

Correspondence: Amyn Haji, M.D., King’s Institute of Therapeutic Endoscopy, King’s College Hospital, NHS Foundation Trust, Denmark Hill, London SE5 9RS, United Kingdom. E-mail:

© 2018 The American Society of Colon and Rectal Surgeons