Endoscopic mucosal resection of colorectal adenomas > 20 mm: Risk factors for recurrence

Abstract Background and study aims Risk factors for colorectal adenoma recurrence after endoscopic mucosal resection (EMR) have been well documented. We assessed the efficacy of the newer 190 colonoscope versus the standard 180 colonoscope for complete resection of lateral spreading lesions. Patients and methods A single-center, retrospective study of patients who underwent EMR with Olympus 180 or 190 colonoscopes from January 1, 2010 to September 30, 2016. We included patients with lesions ≥ 20 mm and surveillance colonoscopy (SC1) after index EMR. A propensity score approach with inverse probability weighting was used to control for potential confounders. A secondary aim was to identify risk factors for recurrence and assess the applicability of the Sydney EMR recurrence tool (SERT) by grading each lesion of our cohort and analyzing associations with recurrence. Results Two hundred ninety-one lesions met inclusion criteria for the study. Odds ratio (OR) for recurrence with the 190 colonoscope was 1.06 (P = .85). Adenoma size (P = .02) and use of argon plasma coagulation (APC; P < .001) were risk factors for recurrence. Lesions with SERT scores > 0 had a higher recurrence risk during follow-up (32 % vs 21 %; OR 1.71; P = .05). Lesions with SERT scores = 0 reached a plateau for recurrence at 12 and 18 months in Kaplan-Meier curves. Conclusions The use of 190 colonoscopes did not measurably affect adenoma recurrence at SC1. Recurrence was associated with adenoma size, complementary APC for resection, and SERT scores > 0. Lesions with SERT scores = 0 that remain negative for recurrence at 18 months may return to routine surveillance.

Download Full-text

Risk factors associated with adenoma recurrence following cold snare endoscopic mucosal resection of polyps ≥ 20 mm: a retrospective chart review

Endoscopy International Open ◽

10.1055/a-1399-8398 ◽

2021 ◽

Vol 09 (06) ◽

pp. E867-E873

Author(s):

Suraj Suresh ◽

Jinyu Zhang ◽

Abdelwahab Ahmed ◽

Mouhanna Abu Ghanimeh ◽

Ahmed Elbanna ◽

...

Keyword(s):

Risk Factors ◽

Endoscopic Mucosal Resection ◽

Chart Review ◽

Retrospective Chart Review ◽

Surveillance Colonoscopy ◽

Factors Associated ◽

Adenoma Recurrence ◽

Mucosal Resection ◽

Risk Factors For Recurrence

Abstract Background and study aims Cold snare endoscopic mucosal resection (EMR) is being increasingly utilized for non-pedunculated polyps ≥ 20 mm due to adverse events associated with use of cautery. Larger studies evaluating adenoma recurrence rate (ARR) and risk factors for recurrence following cold snare EMR of large polyps are lacking. The aim of this study was to define ARR for polyps ≥ 20 mm removed by cold snare EMR and to identify risk factors for recurrence. Patients and methods A retrospective chart review of colon cold snare EMR procedures performed between January 2015 and July 2019 at a tertiary care medical center was performed. During this period, 310 non-pedunculated polyps ≥ 20 mm were excised using cold snare EMR with follow-up surveillance colonoscopy. Patient demographic data as well as polyp characteristics at the time of index and surveillance colonoscopy were collected and analyzed. Results A total of 108 of 310 polyps (34.8 %) demonstrated adenoma recurrence at follow-up colonoscopy. Patients with a higher ARR were older (P = 0.008), had endoscopic clips placed at index procedure (P = 0.017), and were more likely to be Asian and African American (P = 0.02). ARR was higher in larger polyps (P < 0.001), tubulovillous adenomas (P < 0.001), and polyps with high-grade dysplasia (P = 0.003). Conclusions Although cold snare EMR remains a feasible alternative to hot snare polypectomy for resection of non-pedunculated polyps ≥ 20 mm, endoscopists must also carefully consider factors associated with increased ARR when utilizing this technique.

Download Full-text

Faculty Opinions recommendation of Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718479264.793499466 ◽

2014 ◽

Author(s):

Prateek Sharma ◽

Jesica Brown

Keyword(s):

Risk Factors ◽

Endoscopic Mucosal Resection ◽

Wide Field ◽

Adenoma Recurrence ◽

Mucosal Resection ◽

Ace Study

Download Full-text

Risk factors for colon adenomas recurrence after endoscopic mucosal resection

Koloproktologia ◽

10.33878/2073-7556-2021-20-1-10-16 ◽

2021 ◽

Vol 20 (1) ◽

pp. 10-16

Author(s):

Yu. E. Vaganov ◽

V. V. Veselov ◽

A. A. Likutov ◽

E. A. Khomyakov ◽

S. V. Chernyshov ◽

...

Keyword(s):

Risk Factors ◽

Endoscopic Mucosal Resection ◽

Disease Recurrence ◽

Morbidity Rate ◽

Severe Dysplasia ◽

En Bloc ◽

Mucosal Resection ◽

Colon Adenomas ◽

Independent Risk Factors ◽

Mucosal Fold

Aim: to identify risk factors for neoplasms recurrence removed by endoscopic mucosal resection (EMR).Patients and methods: the single-center retrospective observational study included 207 patients with 260 benign colon neoplasms. There were 95 (45.9%) males and 112 (54.1%) females. The median age of the patients was 67 (27-80) years. The results obtained were assessed using following criteria: morbidity rate, complication type, hospital stay, tumor site, number of neoplasms in colon, lateral growth, fragmentation rate, technical difficulties (mucosal fold convergence)during surgery, grade of dysplasia, recurrence rate.Results: intraoperative fragmentation of the neoplasms during mucosectomy occurred in 48/260 (18.5%) cases. Postoperative complications within the period of up to 30 days occurred in 13/207 (6.3%) patients. The most frequent 9 (4.2%) postoperative complication arising after mucosectomy was post-polypectomy syndrome. Another 4 (2.0%) patients produced bleeding after the surgery, which required repeated endoscopic procedure. No mortality occurred. The tumor size exceeding 25 mm (Exp (B) = 0.179; 95% CI = 0.05-0.7; p = 0.014), severe dysplasia (Exp (B) = 0.113; 95% CI = 0.03-0.4; p = 0.001) and fold convergence (Exp (B) = 0.2; 95% CI = 0.07-0.7; p = 0.015) are independent risk factors for disease recurrence.Conclusion: mucosectomy is indicated for colon adenomas if its size does not exceed 25 mm and can be removed en bloc.

Download Full-text