A staged hybrid technique for large benign colorectal polyps with severe fibrosis: a retrospective cohort study
File(s)
Published version
Author(s)
Eckersley, Rob
Humphries, Adam
Saunders, Brian
Type
Journal Article
Abstract
Background and aims Severe submucosal fibrosis presents a major challenge during endoscopic resection (ER) of large colorectal polyps, often precluding standard endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). This challenge is particularly relevant in elderly or comorbid patients when procedural safety is paramount. We describe the safety and efficacy of the novel Polyp Excision with Thermal Ablation and avuLsion (PETAL) technique, a staged hybrid approach combining wide-field EMR, thermal ablation, and avulsion.
Methods This retrospective cohort study included consecutive patients undergoing PETAL for benign-appearing colorectal polyps ≥20 mm with severe fibrosis between January 2015 and December 2024. Primary outcomes included adverse events and recurrence at follow-up. Secondary outcomes included eradication rates and the need for surgery.
Results Sixty-nine patients were included (median age, 71 years; 38% ASA III-IV; 20% on antithrombotics). The median lesion size was 50 mm, with 13.0% recurrent lesions. Delayed bleeding occurred in 2.9%, with no perforations or deep mural injuries. Follow-up data were available for 61 patients (88%), with median duration 40 months. Recurrence at first follow-up was 45.9%, but typically small and amenable to repeat endoscopic therapy. Cumulative eradication rates were 91.1% and 98.2% at the second and third follow-ups, respectively. One patient required surgery.
Conclusions PETAL is a safe and effective strategy for large colorectal polyps with severe fibrosis, achieving high rates of eventual eradication despite frequent early recurrence. Its staged, low-risk profile makes it particularly suitable for elderly or comorbid patients and may represent an alternative to higher-risk techniques such as ESD and full-thickness resection.
Methods This retrospective cohort study included consecutive patients undergoing PETAL for benign-appearing colorectal polyps ≥20 mm with severe fibrosis between January 2015 and December 2024. Primary outcomes included adverse events and recurrence at follow-up. Secondary outcomes included eradication rates and the need for surgery.
Results Sixty-nine patients were included (median age, 71 years; 38% ASA III-IV; 20% on antithrombotics). The median lesion size was 50 mm, with 13.0% recurrent lesions. Delayed bleeding occurred in 2.9%, with no perforations or deep mural injuries. Follow-up data were available for 61 patients (88%), with median duration 40 months. Recurrence at first follow-up was 45.9%, but typically small and amenable to repeat endoscopic therapy. Cumulative eradication rates were 91.1% and 98.2% at the second and third follow-ups, respectively. One patient required surgery.
Conclusions PETAL is a safe and effective strategy for large colorectal polyps with severe fibrosis, achieving high rates of eventual eradication despite frequent early recurrence. Its staged, low-risk profile makes it particularly suitable for elderly or comorbid patients and may represent an alternative to higher-risk techniques such as ESD and full-thickness resection.
Date Issued
2026-08-12
Date Acceptance
2026-07-28
Citation
Endoscopy International Open, 2026, 14
ISSN
2364-3722
Publisher
Georg Thieme Verlag KG
Journal / Book Title
Endoscopy International Open
Volume
14
Copyright Statement
© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
License URL
Identifier
10.1055/a-2926-6624
Subjects
endoscopy lower GI tract
polyps/adenomas/...
endoscopic resection (polypectomy
ESD
EMRc
Publication Status
Published
Article Number
a29266624
Date Publish Online
2026-08-12