Resection outcomes of large sessile polyps: a single centre study

Aims The aim of this study was to assess recurrence rates of large sessile polyps (> 20mm) and to evaluate the variables which predict recurrence in a single centre tertiary unit.

Methods In this retrospective single centre tertiary referral study, we included 467 patients who had large (> 20mm) sessile polyps resected between January 2020 and January 2024 within University College London Hospital. Data regarding patient characteristics, polyp size, optical characteristics, location, number, endoscopist experience, resection technique and histopathological diagnosis were collected retrospectively from the electronic healthcare record.

Results A total number of 467 patients were included in the study. Patients were predominantly male (53.5%), with a mean age of 63.4±14.6 years. The majority of polyps were between 20-29mm (55.9%), with a mean size of 32mm. 395 (84.6%) were non-pedunculated polyps. The polyps were predominantly located in the ascending colon (20.3%), rectum (16.7%) and sigmoid (15.2%). The Kudo Classification was used to help optically characterise each polyp. 111(23.8%) were type II, 47(10/1%) were type IIIs, 141(30.2%) were type IIIL, 150 (32.1%) were type IV. The majority of polyps, 282 (60.4%), were removed by interventional colonoscopists, 105 (22.5%) by trainees, 61(13.1%) by nurse endoscopists and 19 (4.1%) polyps by general colonoscopists. 217 of the polyps (46.5%) were removed by hot snare polypectomies. 123 (26.3%) of the polyps were removed by cold snare polypectomies. 96 (20.6%) of the polyps were removed by ESD and 31 (6.6%) by hybrid ESD. 203 (43.5%) of the polyps were removed en-bloc. Snare tip soft coagulation (STSC) was applied on 73 (15.6%) of the cases. A total of 286 (61.2%) polyps removed had LGD, 44 (9.4%) had HGD, 107 polyps (22.9%) had no dysplasia and 25 (5.35%)w polyps had cancer Surveillance endoscopies were carried out in 88.7% (414/467) patients. Recurrence rate was 4.8% (13/269). Results of multivariate analysis showed that the general colonoscopists had the highest recurrence rates (p=0.0029), followed by trainee gastroenterologists with interventional colonoscopists having the lowest recurrence rates. The recurrence rates in nurse endoscopists and trainee gastroenterologists were not statistically significant (p=0.1034) and (p=0.0985) respectively.STSC reduced reoccurrence (p=0.015). Removing the polyp en- bloc reduced recurrence rates (p=0.01). The larger the polyp size, the higher likelihood of recurrence (p=0.004).

Conclusions Endoscopic experience, polyp size, endoscopic technique all are important variables in predicting polyp recurrence post polypectomy. Services need to consider concentrating large polyp removal into the hands of expert interventional colonoscopists, but low (< 5%) recurrence rates are achievable with modern methods to prevent recurrence.

Conflicts of Interest

Speaker Fees: MedtronicConsultancy: Odin Vision Ltd, Olympus, Boston scientific, Norgine

Publication History

Article published online:
27 March 2025