Comparison of precutting endoscopic mucosal resection and endoscopic submucosal dissection for large (20–30 mm) flat colorectal lesions

Oh, Chang Kyo; Cho, Young Wook; Choi, In Hyoung; Lee, Han Hee; Lim, Chul-Hyun; Kim, Jin Su; Lee, Bo‐In; Cho, Young-Seok

doi:10.1111/jgh.15744

Cited by 5 publications

(1 citation statement)

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“…Although some studies have confirmed the superiority of EMR-P to CEMR for large polyps (> 20 mm)[ 12 , 36 ], even noninferior to ESD[ 37 , 38 ], only one other study has directly compared the efficiency of EMR-P with CEMR in medium-sized polyps[ 11 ]. That study reported that EMR-P had a higher complete resection rate (87.8% vs 67.3%; P < 0.001) and en bloc resection rate (98.0% vs 85.7%; P < 0.004) than CEMR.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic mucosal resection-precutting vs conventional endoscopic mucosal resection for sessile colorectal polyps sized 10-20 mm

Zhang¹,

Sang²,

Xu³

et al. 2022

World J Gastroenterol

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BACKGROUND The optimal method to remove sessile colorectal lesions sized 10-20 mm remains uncertain. Piecemeal and incomplete resection are major limitations in current practice, such as endoscopic mucosal resection (EMR) and cold or hot snare polypectomy. Recently, EMR with circumferential precutting (EMR-P) has emerged as an effective technique, but the quality of current evidence in comparative studies of conventional EMR (CEMR) and EMR-P is limited. AIM To investigate whether EMR-P is superior to CEMR in removing sessile colorectal polyps. METHODS This multicenter randomized controlled trial involved seven medical institutions in China. Patients with colorectal polyps sized 10-20 mm were enrolled and randomly assigned to undergo EMR-P or CEMR. EMR-P was performed following submucosal injection, and a circumferential mucosa incision (precutting) was conducted using a snare tip. Primary outcomes included a comparison of the rates of en bloc and R0 resection, defined as one-piece resection and one-piece resection with histologically assessed clear margins, respectively. RESULTS A total of 110 patients in the EMR-P group and 110 patients in the CEMR group were finally evaluated. In the per-protocol analysis, the proportion of en bloc resections was 94.3% [95% confidence interval (CI): 88.2%-97.4%] in the EMR-P group and 86% (95%CI: 78.2%-91.3%) in the CEMR group ( P = 0.041), while subgroup analysis showed that for lesions > 15 mm, EMR-P also resulted in a higher en bloc resection rate (92.0% vs 58.8% P = 0.029). The proportion of R0 resections was 81.1% (95%CI: 72.6%-87.4%) in the EMR-P group and 76.6% (95%CI: 68.8%-84.4%) in the CEMR group ( P = 0.521). The EMR-P group showed a longer median procedure time (6.4 vs 3.0 min; P < 0.001). No significant difference was found in the proportion of patients with adverse events (EMR-P: 9.1%; CEMR: 6.4%; P = 0.449). CONCLUSION In this study, EMR-P served as an alternative to CEMR for removing nonpedunculated colorectal polyps sized 10-20 mm, particularly polyps > 15 mm in diameter, with higher R0 and en bloc resection rates and without increasing adverse events. However, EMR-P required a relatively longer procedure time than CEMR. Considering its potential benefits for en bloc and R0 resection, EMR-P may be a promising technique in colorectal polyp resection.

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