En Bloc Resection for 10–20 mm Polyps to Reduce Post Colonoscopy Cancer and Surveillance

Hassan, Cesare; Rutter, Matt; Repici, Alessandro

doi:10.1016/j.cgh.2019.04.022

Cited by 4 publications

(5 citation statements)

References 13 publications

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“…Villous architecture displayed a stepwise increased effect from tubular to villous adenomas. Finally, nonpedunculated morphology of index adenoma was modestly associated with advanced adenoma on S1; we feel this is most likely explained by incomplete polyp resection, as supported by previous publications 14 15 .…”

Section: Discussionsupporting

confidence: 84%

Colorectal cancer and advanced adenoma incidence during post-polypectomy surveillance: a national cohort study in the English Bowel Cancer Screening Programme

et al. 2023

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Background Improved colonoscopy quality has led to debate about whether all post-polypectomy surveillance is justified. We evaluated surveillance within the English Bowel Cancer Screening Programme (BCSP) to determine the yield of surveillance and identify predictive factors for surveillance outcome. Methods We performed a retrospective cohort study of individuals undergoing post-polypectomy surveillance between July 2006 and January 2017. BCSP records were linked to the National Cancer Registration Database to identify interval-type post-colonoscopy colorectal cancers (CRCs). Advanced adenoma and CRC at surveillance were documented. CRC incidence was compared with the general population using standardized incidence ratios (SIRs). Predictors of advanced adenomas at first surveillance (S1), and CRC during follow-up, were identified. Results 44 151 individuals (23 078 intermediate risk; 21 073 high risk) underwent 64 544 surveillance episodes. Advanced adenoma and CRC yields were, respectively, 10.0 % and 0.5 % at S1, 8.5 % and 0.4 % at S2, and 10.8 % and 0.4 % at S3. S1 yield was lowest in those with one index adenoma ≥ 10 mm (advanced adenoma 6.1 %; CRC 0.3 %). The SIR was 0.76 (95 %CI 0.66–0.88), accounted for by the intermediate risk group (intermediate risk SIR 0.61, 95 %CI 0.49–0.75; high risk SIR 0.95, 95 %CI 0.79–1.15). Adenoma multiplicity, presence of a large nonpedunculated adenoma, and greater villous component were associated with advanced adenoma at S1. Older age and multiplicity were significantly associated with CRC risk. Conclusion This large, national analysis found low levels of CRC in those undergoing surveillance and low advanced adenoma yield in most subgroups. Less intensive surveillance in some subgroups is warranted, and surveillance may be avoided in those with a single large adenoma.

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Section: Discussionsupporting

confidence: 84%

Colorectal cancer and advanced adenoma incidence during post-polypectomy surveillance: a national cohort study in the English Bowel Cancer Screening Programme

et al. 2023

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“…possibly because it is more difficult to study [11]. However, given that most high-risk adenomas are 10 to 20 mm and how commonly these are encountered by endoscopists in clinical practice, this is an important field that deserves further attention [18] Our study provides knowledge on potential predictors of failed en bloc EMR during training. Polyp size, particularly those larger than 17 mm, was identified as an independent predictor of failed en bloc EMR.…”

Section: Discussionmentioning

confidence: 97%

“…Yet EMR technique and quality, particularly for polyps ≤ 20 mm, have traditionally garnered less attention than other metrics such as adenoma detection rate and cecal intubation, possibly because it is more difficult to study 11 . However, given that most high-risk adenomas are 10 to 20 mm and how commonly these are encountered by endoscopists in clinical practice, this is an important field that deserves further attention 18 …”

Section: Discussionmentioning

confidence: 99%

Endoscopic resection outcomes and predictors of failed en bloc endoscopic mucosal resection of colorectal polyps ≤ 20 mm among advanced endoscopy trainees

et al. 2021

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Background and study aims En bloc endoscopic mucosal resection (EMR) is preferred over piecemeal resection for polyps ≤ 20 mm. Data on colorectal EMR training are limited. We aimed to evaluate the en bloc EMR rate of polyps ≤ 20 mm among advanced endoscopy trainees and to identify predictors of failed en bloc EMR. Methods This was a multicenter prospective study evaluating trainee performance in EMR during advanced endoscopy fellowship. A logistic regression model was used to identify the number of procedures and lesion cut-off size associated with an en bloc EMR rate of ≥ 80 %. Multivariate analysis was performed to identify predictors of failed en bloc EMR. Results Six trainees from six centers performed 189 colorectal EMRs, of which 104 (55 %) were for polyps ≤ 20 mm. Of these, 57.7 % (60/104) were resected en bloc. Trainees with ≥ 30 EMRs (OR 6.80; 95 % CI: 2.80–16.50; P = 0.00001) and lesions ≤ 17 mm (OR 4.56;95 CI:1.23–16.88; P = 0.02) were more likely to be associated with an en bloc EMR rate of ≥ 80 %. Independent predictors of failed en bloc EMR on multivariate analysis included: larger polyp size (OR:6.83;95 % CI:2.55–18.4; P = 0.0001), right colon location (OR:7.15; 95 % CI:1.31–38.9; P = 0.02), increased procedural difficulty (OR 2.99; 95 % CI:1.13–7.91; P = 0.03), and having performed < 30 EMRs (OR: 4.87; 95 %CI: 1.05–22.61; P = 0.04). Conclusions In this pilot study, we demonstrated that a relatively low proportion of trainees achieved en bloc EMR for polyps ≤ 20 mm and identified procedure volume and lesion size thresholds for successful en bloc EMR and independent predictors for failed en bloc resection. These preliminary results support the need for future efforts to define EMR procedure competence thresholds during training.

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“…[5][6][7][8][9] This is the case with those lesions that require an en bloc resection to establish a precise histologic evaluation and determine the risk of lymph node or distant metastasis due to occult superficial cancer. [10][11][12] A dedicated setting is also required for those locations where the risk of adverse events is potentially life threatening, such as the duodenum or the esophagus. 13,14 In a few words, whenever the outcome of an endoscopic resection will heavily affect the oncologic outcome of our patients, or when the risk of the procedure is higher, it is better to take a step back and to refer the patient to a dedicated session of advanced endoscopic resection or to refer the patient to a team who may deal with advanced tissue resection.…”

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confidence: 99%

How to Incorporate Advanced Tissue Resection Techniques in Your Institution

2022

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En Bloc Resection for 10–20 mm Polyps to Reduce Post Colonoscopy Cancer and Surveillance

Cited by 4 publications

References 13 publications

Colorectal cancer and advanced adenoma incidence during post-polypectomy surveillance: a national cohort study in the English Bowel Cancer Screening Programme

Colorectal cancer and advanced adenoma incidence during post-polypectomy surveillance: a national cohort study in the English Bowel Cancer Screening Programme

Endoscopic resection outcomes and predictors of failed en bloc endoscopic mucosal resection of colorectal polyps ≤ 20 mm among advanced endoscopy trainees

How to Incorporate Advanced Tissue Resection Techniques in Your Institution

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