Endoscopic resection of sessile colonic polyps

Background: Sessile polyps are generally considered one of the most difficult polyps to remove endoscopically many polyps that might be considered endoscopically resectable are sent for surgical resection. Many endoscopists appear to refer large sessile polyps for surgical resection. Indeed, there is incentive to remove them endoscopically. sessile polyps are associated with the greatest risk of postpolypectomy bleeding and of perforation. They may take a substantial amount of time to remove. Aim of the work: The aim of the work is to view the role of endoscopy in resection of sessile colonic polyps and review different techniques of endoscopic resection identifing their safety and efficacy. Time consuming, rate of complete and incomplete resection, complications as bleeding or perforation intra operative or delayed post operatively, rate of recurrancy and rate of convertion to surgery. Patient and Methods: A prospective study was held in Al-Azhar University Hospitals between A total of 20 patients with sessile colonic polyps were included in this study who were admitted for endoscopic resection Biopsy foreceps in complete resection of colonic polyps in: 7 cases (35%) Endoscopic sub mucosal resection (EMR) technique using submucosal injection in: 5 cases (25%). Cold snare technique in: 4cases (20%) and Hot snare technique in: 4cases(20%). at the Department of Surgeryof Sayed Galaal Hospital Alazhar University during the period from February 2019 to October 2019. Results: Location of sessile polyps detected - sigmoid colon: 7 cases (35%), - ascending colon and caecum : 10 cases (50%) - descendin colon : 2 cases(10%) ,- transverse colon: 1 case (5%). Size of polyps detected ranged from (0.5 mm to 40mm). The majority of polyps (83.3%) removed (including both successful and incomplete resection) were benign. These included tubular (n = 9), villous (n = 4), and tubulovillous adenomas (n = 4). In addition, one case serrated adenoma and one hyperplastic polyp were removed. Invasive adenocarcinoma . Complete resection occurred in 95% cases, one case failed to be resected during technique failed. Bleeding during procedure occurred in one case (5%), and that settled spontaneously, delayed bleeding occurred in one case(5%) after two weeks and blood transfusion was done . ,perforation occurred in one case that transferred to surgical interference (5% of cases) ; transverse colostomy was done and after one month we use colonoscopy to be sure that perforation completely healed and then closure colostomy was done. Conclusion: Endoscopic resection of sessile colonic polyps presents a number of unique challenges. the majority of benign sessile colonic polyps can be safely and successifully removed endoscopically There are more than one procedure for endoscopic resection according to size, shape and location of the polyps in our study we use biopsy foreceps for small polyps cold snare and hot snare techniques for polyps in larger size and endoscopic mucosal resection for the largest polyps . submucosal saline injection is important in lifting the mucosa of the flat or sessile polyps and makes it easier for complete resection.now surgical transferring is only for complicated cases or failed endoscopy not the first choise.