EP515 - Rectal Polyps Referred for Advanced Endoscopic Resection: Which Lesions Warrant Further Staging?

Sunday, May 11, 2025

2:46 PM – 2:51 PM PT

Location: Monitor 7, Sails Pavilion, Upper Level

ePoster Presenter(s)

Olivia Ziegler, MD

General Surgery Resident
Penn State Milton S. Hershey Medical Center - Hershey, PA
Penn State Milton S Hershey Medical Center
Hershey, PA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

AG

Alicia C. Greene, DO

General Surgery Resident
Penn State Milton S Hershey Medical Center
Herhsey, Pennsylvania, United States

Disclosure information not submitted.
MM

Marc M. Mankarious, MD

General Surgery Resident
Penn State Milton S Hershey Medical Center
Herhsey, PA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Austin Portolese, MD

General Surgery Resident
Penn State Health
Hershey, Pennsylvania, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
LC

Laura E. Cooper, MD

Fellow
Penn State Milton S. Hershey Medical Center, Division of Colon and Rectal Surgery
Hershey, Pennsylvania, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
PL

Patricio B. Lynn, MD

Assistant Professor of Surgery
Penn State Milton S. Hershey Medical Center, Division of Colon and Rectal Surgery
Hershey, Pennsylvania, United States

Disclosure information not submitted.
AK

Audrey S. Kulaylat, MD, MSc

Assistant Professor of Surgery
Penn State Milton S Hershey Medical Center, Division of Colon and Rectal Surgery
Hershey, Pennsylvania, United States

Disclosure information not submitted.
JS

Jeffrey S. Scow, MD

Associate Professor of Surgery
Penn State Milton S. Hershey Medical Center, Division of Colon and Rectal Surgery
Hershey, Pennsylvania, United States

Disclosure information not submitted.
MM

Matthew T. Moyer, MD, MS, FASGE

Professor
Penn State Hershey Medical Center and Penn State Cancer Institute
Hershey, Pennsylvania, United States

Disclosure information not submitted.

Senior Author(s)

MD

Michael J. Deutsch, MD

Associate Professor
Penn State Milton S Hershey Medical Center, Division of Colon and Rectal Surgery
Herhsey, Pennsylvania, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Olivia Ziegler, MD: This individual has no financial relationships with ineligible companies.

Marc M. Mankarious, MD: This individual has no financial relationships with ineligible companies.

Austin Portolese, MD: This individual has no financial relationships with ineligible companies.

Laura E. Cooper, MD: This individual has no financial relationships with ineligible companies.

Michael J. Deutsch, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are advanced treatment modalities for the management of rectal polyps. While these minimally invasive approaches spare patients the morbidity of an extirpative operation, attempting to remove a malignant lesion will often lead to treatment failure, complicate post-EMR staging, and may lead to surgical treatment delays. This can be more significant for rectal malignancies where MRI would be indicated and post EMR effects can give the lesion the false appearance of a more advanced stage. Here, we review institutional data regarding polyp features and subsequent risk of inappropriate resection of occult advanced carcinomas.

Methods/Interventions: This is a retrospective review of institutional data from 2017-2023 of individuals undergoing advanced endoscopic resection of rectal polyps (within 15 cm of the dentate line) with our gastroenterology interventional endoscopy group. Those undergoing resection of non-rectal polyps were excluded. Patient demographics and polyp features were abstracted including Paris and NICE classifications. Outcomes evaluated include final pathologic stage, rates of missed advanced disease, and need for surgical resection. Student t test was employed with preselected alpha of 0.05.

Results/Outcomes: 55 patients met inclusion criteria, 40% of whom were female with a mean age of 65 years. 22 (44%) individuals were found to have adenocarcinoma in the endoscopically resected specimen, while the remaining 28 had high grade dysplasia, or tubulovilious adenomas. Of individuals with malignant polyps, 8 (14.5%) required formal surgical resection for advanced disease (greater than stage T1, or nodal involvement), while the remainder required repeat endoscopic resection for margins or residual disease.

Polyp size varied considerably but did not differ significantly between groups (38.8 mm (no malignancy) vs 29.5 mm (malignancy), p = 0.218). Of those individuals who eventually required surgical resection for advanced disease, 75% had a NICE III classification, while the rest were NICE II. Those with malignancy had a higher median NICE than did those without (2.5 vs 2, p < 0.001). Paris classifications are available in table 1.

Conclusion/Discussion: Advanced endoscopy is an increasingly important tool in the management of rectal polyps; however, the rates of advanced malignancy and subsequent surgical resection reported here are significant. Given these data, evaluation of the role of endoscopic ultrasound, especially in those with higher NICE or Paris classifications, might be considered directly prior to EMR or ESD. This approach should be evaluated with an aim to prevent the resection of polyps with occult advanced malignancy while not adding significant morbidity, time, cost or effort to patients or providers.