Adenoma recurrence after endoscopic mucosal resection: propensity score analysis of old and new colonoscopes and Sydney recurrence tool implementation

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.

Outcomes of Gastrointestinal Polyps Resected Using Underwater Endoscopic Mucosal Resection (UEMR) Compared to Conventional Endoscopic Mucosal Resection (CEMR)

“…Our study highlights the risk of polyp recurrence at a surveillance endoscopy for the follow-up of an index polyp removed using CEMR and UEMR. Many studies have evaluated clinical and endoscopic predictors for recurrence [24,[26][27]. Our study showed a clear association between polyp size and degree of dysplasia and polyp recurrence, supporting what previous studies have consistently shown [19].…”

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

“…For example, we did not include epinephrine in the injection fluid. Recent studies have shown that intraprocedural hemorrhage is associated with an increased risk of residual lesion 12 , and anecdotally cold resection without epinephrine is clearly associated with a bloodier intraprocedural endoscopic field than when epinephrine is included in the injectate. Further, we did encounter some cases of persistent bleeding that was more than generalized oozing and included visible arterial hemorrhage, which we treated in some cases by clip application (Table 1).…”

“…However, the number of patients reported with cold piecemeal resection of large serrated lesions without submucosal injection is smaller. In general, cold resection techniques appear safer than resection techniques using electrocautery [5][6][7][8][9][10][11][12] , with a much reduced or negligible risk of delayed postpolypectomy hemorrhage, and negligible risk of postpolypectomy syndrome and perforation.…”

Adenoma Recurrence after Endoscopic Piecemeal Mucosal Resection of Colorectal Flat Lesions: Applicability of the Sydney EMR Recurrence Tool in a Non-Tertiary Centre

“…However, we could not demonstrate an association between HGD and adenoma recurrence at 6 months. Previous research also failed to demonstrate this association [6, 9]. Arguably, a higher number of patients would be necessary to evaluate the association of HGD with 6-month adenoma recurrence, as was performed by Tate et al [8].…”

“…Some endoscopic features and procedural variables have been linked to greater risk of recurrent adenoma. Several studies demonstrated the association between large lesion size and adenoma recurrence [ 6 , 7 , 8 , 9 ]. Additionally, localization in the right colon, namely involving the ileocecal valve or the appendix orifice, and intraprocedural bleeding (IPB) were also associated with recurrent lesions [ 6 , 7 ].…”