The size, morphology, site, and access score predicts critical outcomes of endoscopic mucosal resection in the colon

Endoscopy ◽  
2018 ◽  
Vol 50 (07) ◽  
pp. 684-692 ◽  
Author(s):  
Mayenaaz Sidhu ◽  
David Tate ◽  
Lobke Desomer ◽  
Gregor Brown ◽  
Luke Hourigan ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Mucosal Resection ◽  
Clinical Score ◽  
Control Measures ◽  
Single Session ◽  
Mucosal Resection ◽  
Endoscopic Recurrence ◽  
Increased Risk ◽  
Site Access ◽  
Clinically Significant

Abstract Background The SMSA (size, morphology, site, access) polyp scoring system is a method of stratifying the difficulty of polypectomy through assessment of four domains. The aim of this study was to evaluate the ability of SMSA to predict critical outcomes of endoscopic mucosal resection (EMR). Methods We retrospectively applied SMSA to a prospectively collected multicenter database of large colonic laterally spreading lesions (LSLs) ≥ 20 mm referred for EMR. Standard inject-and-resect EMR procedures were performed. The primary end points were correlation of SMSA level with technical success, adverse events, and endoscopic recurrence. Results 2675 lesions in 2675 patients (52.6 % male) underwent EMR. Failed single-session EMR occurred in 124 LSLs (4.6 %) and was predicted by the SMSA score (P < 0.001). Intraprocedural and clinically significant postendoscopic bleeding was significantly less common for SMSA 2 LSLs (odds ratio [OR] 0.36, P < 0.001 and OR 0.23, P < 0.01) and SMSA 3 LSLs (OR 0.41, P  < 0.001 and OR 0.60, P = 0.05) compared with SMSA 4 lesions. Similarly, endoscopic recurrence at first surveillance was less likely among SMSA 2 (OR 0.19, P < 0.001) and SMSA 3 (OR 0.33, P < 0.001) lesions compared with SMSA 4 lesions. This also extended to second surveillance among SMSA 4 LSLs. Conclusion SMSA is a simple, readily applicable, clinical score that identifies a subgroup of patients who are at increased risk of failed EMR, adverse events, and adenoma recurrence at surveillance colonoscopy. This information may be useful for improving informed consent, planning endoscopy lists, and developing quality control measures for practitioners of EMR, with potential implications for EMR benchmarking and training.

scholarly journals Colorectal endoscopic mucosal resection with submucosal injection of epinephrine versus hypertonic saline in patients taking antithrombotic agents: propensity-score-matching analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Daisuke Yamaguchi ◽  
Hisako Yoshida ◽  
Kei Ikeda ◽  
Yuki Takeuchi ◽  
Shota Yamashita ◽  
...  
Keyword(s):  
Propensity Score ◽  
Adverse Events ◽  
Propensity Score Matching ◽  
Endoscopic Mucosal Resection ◽  
Hypertonic Saline ◽  
Colon Polyps ◽  
Antithrombotic Agents ◽  
Submucosal Injection ◽  
Mucosal Resection ◽  
Increased Risk

Abstract Background Endoscopic mucosal resection (EMR) to remove colon polyps is increasingly common in patients taking antithrombotic agents. The safety of EMR with submucosal saline injection has not been clearly demonstrated in this population. Aims The present study aimed to evaluate the efficacy and safety of submucosal injection of saline–epinephrine versus hypertonic saline in colorectal EMR of patients taking antithrombotic agents. Methods This study enrolled 204 patients taking antithrombotic agents among 995 consecutive patients who underwent colonic EMR from April 2012 to March 2018 at Ureshino Medical Center. Patients were divided into two groups according to the injected solution: saline–epinephrine or hypertonic (10%) saline (n = 102 in each group). Treatment outcomes and adverse events were evaluated in each group and risk factors for immediate and post-EMR bleeding were investigated. Results There were no differences between groups in patient or polyp characteristics. The main antithrombotic agents were low-dose aspirin, warfarin, and clopidogrel. Propensity-score matching created 80 matched pairs. Adjusted comparisons between groups showed similar en bloc resection rates (95.1% with saline–epinephrine vs. 98.0% with hypertonic saline). There were no significant differences in adverse events (immediate EMR bleeding, post-EMR bleeding, perforation, or mortality) between groups. Multivariate analyses revealed that polyp size over 10 mm was associated with an increased risk of immediate EMR bleeding (odds ratio 12.1, 95% confidence interval 2.0–74.0; P = 0.001). Conclusions Two tested solutions in colorectal EMR were considered to be both safe and effective in patients taking antithrombotic agents.

Relationship of lymphocyte and eosinophil counts and immune-related adverse events in recipients of programmed death-1 (PD-1) inhibitor therapy: A single-center retrospective analysis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e14586-e14586 ◽  
Author(s):  
Adam Diehl ◽  
Mark Yarchoan ◽  
Ting Yang ◽  
Blake Scott ◽  
Burles Avner Johnson ◽  
...  
Keyword(s):  
Adverse Events ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Absolute Lymphocyte Count ◽  
Multivariate Regression Analysis ◽  
Tumor Type ◽  
Increased Risk ◽  
Investigational Therapies ◽  
Clinically Significant ◽  
Eosinophil Counts

e14586 Background: Inhibition of the PD-1 checkpoint can cause immune activation in non-target tissues, resulting in immune-related adverse events (irAE) in up to 50% of patients. Biomarkers that are associated with irAEs in patients treated with PD-1 inhibitors may have implications for patient selection and clinical management. Methods: We performed an IRB-approved retrospective chart review of adult solid tumor patients treated with nivolumab or pembrolizumab at a single institution from January 2015 until November 2016. Patients were excluded if concurrently receiving investigational therapies, or on unreported clinical trials. Data were collected on treatment history, leukocyte counts, and irAE, defined as adverse events with a potential immunologic basis with grading performed using CTCAE v.4.0. Results: 172 patients were included (lung n = 54; melanoma n = 61; kidney n = 25; esophageal n = 12; bladder n = 8; other tumors n = 12) with median age 67. 18% were treated with concurrent ipilimumab. 31% experienced an adverse event of any grade with a mean time to develop an irAE of 3.5 months. Of those with an irAE, 85% required treatment, 68% were grade ≥ 2, 32% were grade 3 or 4 and 35% required therapy discontinuation due to the irAE. In univariate analysis, a higher ALC at both the start of therapy and at 1 month was associated with increased risk of an irAE of grade ≥ 2 (p < 0.05). A higher absolute lymphocyte count (ALC) or higher absolute eosinophil count (AEC) at 1 month into therapy was associated with increased risk of all irAE (p < 0.05) as well as irAE requiring treatment (p < 0.05). In addition, in a multivariate regression analysis including age, race, tumor type, prior chemotherapy, prior radiation, and concurrent ipilimumab therapy, an ALC > 2000 at the start of therapy was a significant predictor of irAE of grade ≥ 2 (p < 0.05 and OR 2.0), as was an ALC > 2000 at 1 month into therapy (p < 0.05 and OR 1.86). Conclusions: These results suggest that high lymphocyte and eosinophil counts early in the course of anti-PD1 therapy may be associated with a higher risk for clinically significant irAE.

Incidence and prediction of checkpoint inhibitor immune-related nephrotoxicity.

2020 ◽  
Vol 38 (5_suppl) ◽  
pp. 91-91
Author(s):  
Jonathan D Sorah ◽  
Tracy L. Rose ◽  
Roshni Radhakrishna ◽  
Vimal Derebail ◽  
Matthew I. Milowsky
Keyword(s):  
Autoimmune Disease ◽  
Adverse Events ◽  
Checkpoint Inhibitors ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Tumor Type ◽  
True Incidence ◽  
Platinum Based Chemotherapy ◽  
Increased Risk ◽  
Clinically Significant

91 Background: Immune checkpoint inhibitors (ICIs), through inhibition of self-tolerance, have the potential to cause immune-related adverse events that can affect any organ, including the kidneys. Our study aimed to better characterize the incidence of and predictive characteristics for immune-related nephrotoxicity. Methods: All patients at the University of North Carolina (UNC) who received ICIs between April 2014 and December 2018 for any malignancy were identified. Patients on dialysis or those who received concurrent platinum-based chemotherapy were excluded. Any patient who subsequently had a clinically significant acute kidney injury (AKI), defined as a doubling or more of baseline creatinine, was included for analysis. A retrospective chart review was performed to determine the cause of AKI. Any uncertain cases were reviewed by two nephrologists for expert consensus (R.R. and V.D.). Results: 1766 patients received an ICI during the study period. 123 (7%) patients had AKI within one year of the first ICI dose. 14 were due to immune-related nephrotoxicity (11% of patients with AKI and 0.8% of all ICI patients). Pre-existing autoimmune disease was more likely in patients with immune-related nephrotoxicity than in those with non-immune AKI (14% vs 3%, p = 0.04). Similarly, concurrent or prior other immune-related adverse events were more common in patients with immune-related AKI (57% vs 6%, p = 0.01). Patients with immune-related AKI were more likely to see a nephrologist (57% vs 23%, p = 0.007) and had a more profound increase in creatinine from baseline (median 2.6 vs 1.6, p = 0.02). Age, sex, urinalysis findings, and primary tumor type were not associated with increased risk. Conclusions: The true incidence of ICI related nephrotoxicity is difficult to ascertain due to the many confounders that contribute to AKI in this population. Severe immune-related nephrotoxicity is rare, but patients with preexisting autoimmune disease or history of immune-related adverse events are at increased risk.

scholarly journals S281 Predictors of Histologic-Confirmed Endoscopic Recurrence After Endoscopic Mucosal Resection (EMR) of Non-Pedunculated Polyps Larger Than 20 mm

2021 ◽  
Vol 116 (1) ◽  
pp. S123-S124
Author(s):  
Scott N. Berger ◽  
Juan Gomez Cifuentes ◽  
Kadon N. Caskey ◽  
Andre N. Jove ◽  
Allison Boden ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Mucosal Resection ◽  
Endoscopic Recurrence

scholarly journals INCREASED RISK OF SYNCHRONOUS COLORECTAL LESIONS IN PATIENTS REFERRED FOR ENDOSCOPIC MUCOSAL RESECTION OF LATERAL SPREADING TUMORS

2019 ◽  
Vol 56 (3) ◽  
pp. 276-279 ◽  
Author(s):  
Maria Constanza TORELLA ◽  
Belén DUARTE ◽  
Mariano VILLARROEL ◽  
Juan LASA ◽  
Ignacio ZUBIAURRE
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Bowel Preparation ◽  
Lateral Spreading ◽  
Serrated Adenoma ◽  
Index Lesion ◽  
Mucosal Resection ◽  
Increased Risk ◽  
Lateral Spreading Tumor ◽  
Serrated Adenomas ◽  
Synchronous Lesion

ABSTRACT BACKGROUND: Endoscopic mucosal resection is one of the most frequent therapeutic alternatives for large colorectal lateral spreading tumors. There are few data on the prevalence of synchronous lesions on these patients. OBJECTIVE: To describe the prevalence of synchronous colorectal lesions in patients referred for endoscopic mucosal resection of lateral spreading tumors >20 mm. METHODS: We reviewed the endoscopic database of our Department and identified adult patients who were referred for the resection of a colorectal lateral spreading tumor >20 mm and had a diagnostic colonoscopy performed up to six months before. The proportion of patients with at least one synchronous lesion was estimated. The following features were compared between patients with and without synchronous lesions: age, gender, bowel preparation quality and cecal intubation on index colonoscopy and therapeutic colonoscopy, serrated adenoma as index lesion. RESULTS: From December 2016 to November 2017, we identified 70 patients who fulfilled inclusion criteria. Median size of lesions was 25 mm (20-45). Eighty percent were located in the right colon and 35.71% were serrated adenomas. Synchronous lesion rate was 38.57%. Bowel preparation quality was similar in both groups when comparing both index and therapeutic colonoscopies. Patients with synchronous lesions had a higher proportion of serrated adenoma as index lesion than patients without synchronous lesions [51.85% vs 25.58%, OR 3.13 (1.13-8.68), P=0.03]. CONCLUSION: We found a high prevalence of synchronous lesions among patients with a large colorectal lateral spreading tumor. This risk seems to be increased if index lesions are serrated adenomas.

scholarly journals Safety of Endoscopic Mucosal Resection Using a Bipolar Snare for Superficial Nonampullary Duodenal Epithelial Tumors and the Predictive Factors of Piecemeal Resection

Digestion ◽  
2020 ◽  
pp. 1-9
Author(s):  
Masafumi Yamamura ◽  
Yasuaki Nagami ◽  
Taishi Sakai ◽  
Hirotsugu Maruyama ◽  
Masaki Ominami ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Mucosal Resection ◽  
R0 Resection ◽  
En Bloc ◽  
Noninvasive Treatment ◽  
Submucosal Injection ◽  
Mucosal Resection ◽  
Epithelial Tumors ◽  
Bipolar Snare ◽  
Piecemeal Resection

<b><i>Introduction:</i></b> Endoscopic mucosal resection for small superficial nonampullary duodenal epithelial tumors is a noninvasive treatment; however, perforations can occur. Bipolar snares can reduce the risk of perforation due to small tissue damage. Currently, only few studies have reported endoscopic mucosal resection for small superficial nonampullary duodenal epithelial tumors using a bipolar snare and the effect of preoperative findings. <b><i>Objective:</i></b> To investigate (1) resectability and adverse events of endoscopic mucosal resection using a bipolar snare for small superficial nonampullary duodenal epithelial tumors and (2) the predictions of piecemeal resection. <b><i>Methods:</i></b> Between 2007 and 2017, 89 patients with 107 lesions underwent endoscopic mucosal resection using a bipolar snare. Among them, 88 lesions of 77 patients were evaluated. The primary outcome was the incidence of en bloc resection and R0 resection and adverse events. Risk factors associated with piecemeal resection, including preoperative lesion findings, were also examined. <b><i>Results:</i></b> The incidence rates of en bloc and R0 resections were 85.2 and 48.9%, respectively. Neither intraoperative or delayed perforations nor procedure-related mortality was noted. The nonlifting sign after submucosal injection was associated with an increase in piecemeal resection (odds ratio: 20.3, 95% confidence interval: 2.53–162; <i>p</i> = 0.005). <b><i>Conclusion:</i></b> Endoscopic resection for small superficial nonampullary duodenal epithelial tumors can cause perforation; however, endoscopic mucosal resection using a bipolar snare can be a safe treatment option as it does not cause perforations. The nonlifting sign after submucosal injection is a predictive factor for piecemeal resection.

scholarly journals Adverse events and residual lesion rate after cold endoscopic mucosal resection of serrated lesions ≥10 mm

2020 ◽  
Author(s):  
Connor D. McWhinney ◽  
Krishna C. Vemulapalli ◽  
Ahmed El Rahyel ◽  
Noor Abdullah ◽  
Douglas K. Rex
Keyword(s):  
Adverse Events ◽  
Endoscopic Mucosal Resection ◽  
Mucosal Resection ◽  
Residual Lesion ◽  
Serrated Lesions
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