Su1676 knife assisted resection of right-sided colonic polyps: the right way round!

Introduction: Endoscopic resection of right-sided colonic polyps carries an inherently higher risk of complications including bleeding and perforation. This risk is heightened in the resection of polyps that are tethered, flat or on background of colitis (complex polyps). In the West, complex polyps in the right colon are frequently managed by endoscopic mucosal resection (EMR) or surgery although recurrence rates can be as high as 20%. Endoscopic submucosal dissection (ESD) is an effective technique in the resection of complex polyps. However, ESD is technically challenging with a long learning curve and carries a significant perforation rate (6% in Eastern series and 17% in Western series) leading to a poor uptake of this technique in the West. We aim to examine the safety and efficacy of a novel technique of knife assisted snare resection (KAR) in resecting complex polyps in the right colon.

Methods: Data of all KARs undertaken by a single endoscopist in our institution from 2009 to 2015 were prospectively compiled in a pre-designed database. Independent researchers blinded to the technique interrogated this database. Polyps in the right colon (distal transverse to caecum) were included in the analysis. Polyp characteristics and procedure details were prospectively recorded. Endoscopic follow-up was performed to identify recurrence.

Results: A total of 52 patients with complex polyps 10-80mm in size were resected by KAR. The mean follow up time was 35 months. 42% of the polyps were >40mm in size, and 51% were scarred from previous attempts. The majority of the polyps resected (91%) exhibited flat morphology (Paris Classification IIa, IIa+IIb, IIa+IIc). Table 1 shows the patient baseline and lesion characteristics. There were 2 cases of delayed bleeding (4%) neither of which required surgery. The endoscopic cure rate was 96% after single procedure, improving to 98% with further attempts.

Conclusion: This is the first reported Western series of KAR of complex polyps in the right colon. Our data demonstrates that this novel technique is a safe and effective technique for resection of complex polyps in the right colon. The recurrence rates are superior to EMR and complication rates are lower than ESD. As the learning curve for KAR is shorter than that for ESD, we believe that this technique is ideal for the Western setting.