Difficult Colorectal Polyps - Therapeutic Approach
M. Alecu, L. Simion, S. Ionescu, E. Brătucu, N.D. StrajaOriginal article, no. 3, 2015
Introduction: Endoscopic polypectomy is the gold standard in the treatment of colorectal polyps. The importance of polypectomy
rests primarily on the fact that polyp-type lesions present a high risk of malignant degeneration, colorectal polyps being
able, if left unattended therapeutically, to generate a colorectal cancer (CRC) - a lesion with a far more negative prognosis.
Although preferable, endoscopic polypectomy of colorectal polyps is not always possible, multiple factors generating
difficulties in performing this therapeutic measure.
Material and Method: We performed a retrospective study in the First Surgical Clinic of the "Prof. Dr. Alexandu Trestioreanu" Bucharest Oncology Institute, spanning a period of 3 years (2008-2011), in which time 224 patients were diagnosed by colonoscopy with colorectal polyps, of whom 222 patients benefited from endoscopic polypectomy.
The aim of the study was to identify "difficult" polyps and to identify the criteria for endoscopic surgery versus classic
surgery as a therapeutic indication.
Results: Presence of "difficult" polyps was observed in 37.56% of the patients diagnosed with colorectal polyps. In over 88%
of cases endoscopic polypectomy was possible, and for the remaining patients classic surgery was the therapeutic solution
opted for.
Conclusions: Presence of "difficult" polyps generates inconveniences in performing endoscopic polypectomy, increasing the
risk of postoperative complication occurrence, as well as the duration of the operation. If the criteria for characterizing
polyps as "difficult" are relatively well-established, the choice between endoscopic and classic surgery as a therapeutic
measure is left at the free will of the operating surgeon, with the exception of situations in which classic surgery is resorted to for oncological reasons.