Incision-Free Technique Helps Avoid Colon Surgery

Minimally Invasive Surgery Targets Large and Flat Growths in Colon

By Robin O'Connor

Judith McKibben, a retired Bay Area interior designer, had a routine colonoscopy last year that revealed a large, carpetlike growth needing removal. Wanting to avoid surgery that would remove a large section of her colon, Judith sought treatment at California Pacific Medical Center (CPMC).

Overall, about 5 percent of adults present with large polyps, or growths, within the colon during routine colonoscopy screenings. Often these polyps are flat against the colon’s surface or too large to be removed during colonoscopy. While many doctors advocate open or laparoscopic surgery to remove such polyps, another alternative exists.

Advanced Technology Offers Benefits

“We use advanced technology at California Pacific Medical Center to perform an incision-free procedure for large colon polyps: endoscopic mucosal resection,” says Kenneth Binmoeller, M.D., medical director of the Paul May and Frank Stein Interventional Endoscopy Center at CPMC. “This helps individuals who would have otherwise faced surgical removal of part of their colon, which carries greater risk and a lengthy recovery time.”

Judith learned she was a perfect candidate for endoscopic mucosal resection (EMR) after meeting with Dr. Binmoeller. Following her outpatient EMR procedure at CPMC, Judith went home the same day. “Dr. Binmoeller is a miracle worker,” she marvels. “He said I had one of the largest polyps he had ever seen.”

Technique Preserves Colon

As nationwide leaders in interventional endoscopy, Dr. Binmoeller and his colleagues are experts at visualizing abnormalities within the gastrointestinal tract and performing minimally invasive treatments. To date, they have performed more than 1,000 EMR procedures. As a pioneer of endoscopic treatments, Dr. Binmoeller published the first paper on endoscopic resection of giant colorectal polyps back in 1996 (Binmoeller et al, Gastrointestinal Endoscopy 1996; 43:.183-8).

During the EMR procedure, doctors insert a flexible endoscope the thickness of a pencil through the rectum and into the gastrointestinal tract. A tiny light and camera at the tip of the endoscope transmit magnified, high-definition images to a television monitor so the doctor can visualize the inside of the gastrointestinal tract.

To treat growths within the colon, Dr. Binmoeller uses a conduit within the endoscope to apply miniature surgical instruments. “These tiny ultrasound probes enable us to see into and beyond the intestinal wall, and then we can essentially ‘lift’ and remove the polyp and surrounding mucosal tissue in the colon,” he explains.

“Advances in imaging technology such as high-definition video optics enable us to better detect and treat flat growths within the colon before they turn into invasive cancers,” says Dr. Binmoeller.

In comparison to laparoscopic or open surgery, EMR preserves the function of the colon wall so digestion isn’t affected. Additionally, EMR involves less risk and faster recovery. “Amazingly, we can remove affected tissue from nearly two-thirds of the colon wall thickness, leaving only a thin layer of muscle behind,” explains Binmoeller. “Following treatment, healthy tissue grows back, fully restoring that area of the colon.”

Colon Cancer Screening

Starting at age 50, you should get a colonoscopy to screen for abnormalities within your colon. Those with the highest incidence rate for colorectal cancer, according to 2008 data from the Centers for Disease Control (CDC), are blacks, followed by whites, and then Hispanics and Asian/Pacific Islanders.

Studies have found the following risk factors for colorectal cancer:

• Age over 50: Colorectal cancer is more likely to occur as people get older. More than 90 percent of people with this disease are diagnosed after age 50. The average age at diagnosis is 72.


• Colorectal polyps: Polyps are growths on the inner wall of the colon or rectum. They are common in people over age 50. Most polyps are benign (not cancer), but some polyps (adenomas) can become cancer. Finding and removing polyps may reduce the risk of colorectal cancer.


• Family history of colorectal cancer: Close relatives (parents, brothers, sisters, or children) of a person with a history of colorectal cancer are somewhat more likely to develop this disease themselves, especially if the relative had the cancer at a young age. If many close relatives have a history of colorectal cancer, the risk is even greater.


• Genetic alterations: Changes in certain genes increase the risk of colorectal cancer.

Source: National Cancer Institute, Centers for Disease Control.

For more information about EMR and interventional endoscopy services at CPMC, visit cpmc.org/ies.