Adenoma recurrence after piecemeal colonic EMR is predictable: the Sydney EMR recurrence tool

Tate, David J.; Desomer, Lobke; Klein, Amir; Brown, Gregor J.; Hourigan, Luke F.; Lee, Eric Y.T.; Moss, Alan; Ormonde, Donald; Raftopoulos, Spiro; Singh, Rajvinder; Williams, Stephen J.; Zanati, Simon; Byth, Karen; Bourke, Michael J.

doi:10.1016/j.gie.2016.11.027

Cited by 128 publications

(115 citation statements)

References 18 publications

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“…Size is one of the most important and well-described characteristics determining outcomes and difficulty of polypectomy. 6,13,14 Our study corroborated this finding. Indeed, several studies have demonstrated this relationship and proposed different cut-offs to define worse outcomes.…”

Section: Factorsupporting

confidence: 89%

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Risk stratification of colorectal polyps for predicting residual or recurring adenoma using the Size/Morphology/Site/Access score

Barosa

Mohammed²,

Rembacken³

2018

UEG Journal

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Background and Aims: Endoscopic mucosal resection is an effective and safe procedure to manage large non-pedunculated colonic polyps for which residual/recurrent adenoma is the main drawback. Size/Morphology/Site/Access score determines polypectomy difficulty. We aimed to describe residual/recurrent adenoma rate according to Size/Morphology/Site/Access and to select the ize/Morphology/Site/Access cut-off to predict low residual/recurrent adenoma. Methods: This was a retrospective cohort study of endoscopic mucosal resection for large non-pedunculated colonic polyps performed in a tertiary centre. Results: Three hundred and sixteen procedures were included. The mean size of lesions was 34.5 AE 17.1 mm, 59.5% were sessile, 60.4% were in the right colon and in 17.7% (n ¼ 56) the access was difficult. Of the lesions, 83.6% were Size/ Morphology/Site/Access 3-4. Residual/recurrent adenoma at first and second follow-up was significantly lower in Size/ Morphology/Site/Access 2 (1.9% and 0.0%, respectively) when compared to Size/Morphology/Site/Access 3 (18.2%, p ¼ 0.004 and 6.7%, p ¼ 0.049) and Size/Morphology/Site/Access 4 (30.8%, p < 0.001 and 22.7%, p ¼ 0.030). The negative predictive value of Size/Morphology/Site/Access 2 for residual/recurrent adenoma at second follow-up was 86.1%. On multivariate analyses, Size/Morphology/Site/Access 3-4 predicted residual/recurrent adenoma at first (odds ratio 11.96, 95% confidence interval 1.57-91.13) and second follow-up (odds ratio 2.47, 95% confidence interval 1.51-4.22) and had higher cumulative incidence of residual/recurrent adenoma compared to Size/Morphology/Site/Access 2 (p 0.003). Conclusion: Use of the Size/Morphology/Site/Access score allows cases to be identified with a low risk of residual/recurrent adenoma.

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Section: Factorsupporting

confidence: 89%

“…Indeed, several studies have demonstrated this relationship and proposed different cut-offs to define worse outcomes. 13,14 Using the area under the ROC curve of size to predict RRA, we defined a statistically defined cut-off at 32 mm which can be used to reliably predict higher RRA rates.…”

Section: Factormentioning

confidence: 99%

Risk stratification of colorectal polyps for predicting residual or recurring adenoma using the Size/Morphology/Site/Access score

Barosa

Mohammed²,

Rembacken³

2018

UEG Journal

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“…Theoretical economic and psychological benefits to patients of reduced colonoscopic surveillance following ESD is attractive, but currently remains unproven and the excellent outcomes reported by Eastern investigators is attainable by very few Western endoscopists. In addition, although recurrence after EMR is higher than after ESD, it is predictable and most cases are treatable endoscopically . Additionally, use of adjunctive therapies such as STSC to the EMR margin significantly reduces endoscopic recurrence from 21.1% to 6% (relative risk 0.28, P < 0.001) …”

Section: Future Of Western Endoscopic Submucosal Dissectionmentioning

confidence: 99%

Endoscopic submucosal dissection in the West: Current status and future directions

Michael

Bourke

2017

Digestive Endoscopy

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Endoscopic submucosal dissection (ESD) was first conceptually described almost 30 years ago in Japan and is now widely practiced throughout East Asia. ESD expands the boundaries of endoscopic resection (ER) by allowing en bloc resection of large early neoplastic lesions within the gastrointestinal tract (GIT). This offers advantages over other ER techniques by facilitating definitive histological staging and curative treatment of early cancer in selected cases. Indeed, the experience of ESD in Eastern countries is significant, and excellent outcomes from high-volume centers are reported. The potential benefits of ESD are recognized by Western endoscopists, but its adoption has been limited. A number of factors contribute to this, including epidemiological differences in GIT neoplasia between Western and Eastern populations and limitations in training opportunities. In this review, we discuss the role of ESD, its current status and the future in Western endoscopic practice.

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“…After endoscopic resection, we recommend endoscopic follow‐up at 3–6 months, at 12–18 months and then at 3 years from the original resection date. Recurrence rates at 6 months of approximately 20% are reported after piecemeal EMR, with further recurrence appearing at later dates even if the 6‐month site check was clear .…”

Section: Post‐resectionmentioning

confidence: 99%

Endoscopic excision of significant polyp and early colorectal cancer lesions

et al. 2019

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Adenoma recurrence after piecemeal colonic EMR is predictable: the Sydney EMR recurrence tool

Cited by 128 publications

References 18 publications

Risk stratification of colorectal polyps for predicting residual or recurring adenoma using the Size/Morphology/Site/Access score

Risk stratification of colorectal polyps for predicting residual or recurring adenoma using the Size/Morphology/Site/Access score

Endoscopic submucosal dissection in the West: Current status and future directions

Endoscopic excision of significant polyp and early colorectal cancer lesions

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