Ahmad M. Al-Taee, MD, Samer Alkaade, MD
Saint Louis University, St. Louis, MO
Introduction: Endoscopic full thickness resection (EFTR) is a novel endoscopic procedure for management of challenging colorectal lesions. Resection site growths after EFTR are usually concerning for incomplete resection or recurrence of the initial lesion. Here we report two patients who underwent EFTR and had polypoid growth of normal tissue at the site of EFTR on surveillance colonoscopy.
Case Description/Methods: Case 1
A 51 year-old Caucasian male was referred for evaluation of residual sigmoid colon tubulovillous adenoma with focal high grade dysplasia. He has a family history of late onset colorectal cancer in his mother and grandmother. He had no abdominal symptoms and examination was unremarkable.
Colonoscopy revealed residual polypoid tissue at the site of a prior attempted polypectomy for which he underwent EFTR. Surveillance colonoscopy 6 months later showed a 15-mm polyp-like growth at the site of prior EFTR that was lifted and resected with a hot snare (figure 1). Pathology showed benign mesenchymal proliferation.
A 70 year-old Caucasian female was referred to our clinic for evaluation of an incompletely resected 20-mm transverse colon tubular adenoma. Her father developed colon cancer after the age of 60. She had no abdominal symptoms and examination was unremarkable.
Colonoscopy showed a 20-mm transverse colon polyp with overlying scarring. She underwent EFTR and pathology showed tubular adenoma with clear margins. Repeat colonoscopy 6 months later showed a 10-mm polyp-like lesion at the site of previous EFTR that was lifted and resected with a hot snare (figure 2). Pathology showed normal colonic mucosa.
Discussion: EFTR is a novel procedure for management of lesions that are not amenable to conventional endoscopic resection methods such as non-lifting lesions, lesions with high probability of malignancy, and lesions located in difficult anatomic locations. It is an attractive alternative to surgical resection or endoscopic submucosal dissection for management of such lesions.
Resection site growths after EFTR are usually concerning for recurrence. However, polyp-like growths of normal tissue after EFTR were noted in 2 out of 8 patients who underwent EFTR at our institution. Therefore, EFTR site growths may not always represent recurrence of the initial lesion. Awareness of this possibility can alleviate patient anxiety and reduce cost associated with further investigations and resections.
Citation: Ahmad M. Al-Taee, MD, Samer Alkaade, MD. P0157 - NORMAL POLYPOID TISSUE AFTER ENDOSCOPIC FULL THICKNESS RESECTION OF COLONIC LESIONS. Program No. P0157. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.