Efficacy of colonoscopic polypectomy in removing large polyps

Letters to the Editor

ie, an MRI. I appeal to the industry to manufacture clips with nonferromagnetic properties, keeping the best interests of our patients at heart. Gottumukkala S. Raju, MD Department of Gastroenterology, Hepatology, and Nutrition The University of Texas M. D. Anderson Cancer Center Houston, Texas

REFERENCES 1. Raju GS, Gajula L. Endoclips for GI endoscopy. Gastrointest Endosc 2004; 59:267-79. 2. Raju GS, Thompson C, Zwischenberger JB. Emerging endoscopic options in the management of esophageal leaks (videos). Gastrointest Endosc 2005;62:278-86. 3. Raju GS, Kaltenbach T, Soetikno R. Endoscopic mechanical hemostasis of GI arterial bleeding (with videos). Gastrointest Endosc 2007;66:774-85. 4. Raju GS. Endoscopic closure of gastrointestinal leaks. Am J Gastroenterol 2009;104:1315-20. 5. Gill KR, Pooley RA, Wallace MB. Magnetic resonance imaging compatibility of endoclips. Gastrointest Endosc 2009;70:532-6. 6. Khashab M, Rex DK. Persistence of resolution clips on colorectal polypectomy sites. Gastrointest Endosc 2007;66:635-6. doi:10.1016/j.gie.2010.01.020

Efficacy of colonoscopic polypectomy in removing large polyps To the Editor: We read with great interest the article by Swan et al1 in which they described the outcomes of advanced polypectomy techniques in removing large difficult colon polyps from patients referred to a tertiary care center. In this prospective case series, they found that colonoscopic polypectomy of these large polyps performed at a tertiary referral center is highly effective, safe, and results in major

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cost savings compared to surgery. This article might improve awareness among general endoscopists to consider referring patients with difficult polyps to tertiary referral centers with the expertise to treat them, rather than to surgery. Although the mean cost of these procedures was mentioned and was compared to surgical costs, it would be useful to mention the mean cost of a routine colonoscopy in Australia. The average procedure time taken to perform these difficult cases is also not mentioned in the article. This information is important, since some of the deterrents to colonoscopic polypectomy of large polyps are longer procedure times, higher equipment usage, and lack of adequate reimbursement.2 We are also interested to know the outcome of large sessile polyps involving the ileocecal valve (Fig. 1 in the article), since involvement of the ileocecal valve is generally considered a contraindication for colonoscopic polypectomy by experts.3 Madhusudhan R. Sanaka, MD Prashanthi N. Thota, MD Department of Gastroenterology and Hepatology Cleveland Clinic Cleveland, Ohio

REFERENCES 1. Swan MP, Bourke MJ, Alexander S, et al. Large refractory colonic polyps: is it time to change our practice? A prospective study of the clinical and economic impact of a tertiary referral colonic mucosal resection and polypectomy service (with videos). Gastrointest Endosc 2009;70:112836. 2. Overhiser AJ, Rex DK. Work and resources needed for endoscopic resection of large sessile colorectal polyps. Clin Gastroenterol Hepatol 2007;5: 1076-9. 3. Tolliver KA, Rex DK. Colonoscopic polypectomy. Gastroenterol Clin North Am 2008;37:229-51, ix. doi:10.1016/j.gie.2010.01.002

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