Endoscopic mucosal resection for large serrated lesions in comparison with adenomas: a prospective multicentre study of 2000 lesions

Pellisé, María; Burgess, Nicholas G.; Tutticci, Nicholas J.; Hourigan, Luke F.; Zanati, Simon; Brown, Gregor J.; Singh, Rajvinder; Williams, Stephen J.; Raftopoulos, Spiro; Ormonde, Donald; Moss, Alan; Byth, Karen; P’Ng, Heok; Mahajan, Hema; McLeod, Duncan; Bourke, Michael J.

doi:10.1136/gutjnl-2015-310249

Cited by 118 publications

(127 citation statements)

References 38 publications

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“…This recommendation is based on the higher risk of incomplete resection and complications associated with removal of large sessile polyps in the right colon and some evidence of a favourable effect of a threshold volume for better outcomes 102–104. These data, combined with variability in SL detection and assessment (see statements 13 and 14), and data on comparing the similar outcomes on safety of endoscopic resection in adenomas and SSLs,105 suggest a significant role for operator variability and outcomes in the management of these lesions. Therefore, for larger lesions ≥10 mm endoscopists should meet the competencies and standards set out in the BSG 2015 guidelines on management of large non-polypoid colorectal polyps 104…”

Section: Detection and Resection Of Slsmentioning

confidence: 99%

British Society of Gastroenterology position statement on serrated polyps in the colon and rectum

East

Atkin

Bateman

et al. 2017

Gut

273

266

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Serrated polyps have been recognised in the last decade as important premalignant lesions accounting for between 15% and 30% of colorectal cancers. There is therefore a clinical need for guidance on how to manage these lesions; however, the evidence base is limited. A working group was commission by the British Society of Gastroenterology (BSG) Endoscopy section to review the available evidence and develop a position statement to provide clinical guidance until the evidence becomes available to support a formal guideline. The scope of the position statement was wide-ranging and included: evidence that serrated lesions have premalignant potential; detection and resection of serrated lesions; surveillance strategies after detection of serrated lesions; special situations—serrated polyposis syndrome (including surgery) and serrated lesions in colitis; education, audit and benchmarks and research questions. Statements on these issues were proposed where the evidence was deemed sufficient, and re-evaluated modified via a Delphi process until >80% agreement was reached. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool was used to assess the strength of evidence and strength of recommendation for finalised statements. Key recommendation: we suggest that until further evidence on the efficacy or otherwise of surveillance are published, patients with sessile serrated lesions (SSLs) that appear associated with a higher risk of future neoplasia or colorectal cancer (SSLs ≥10 mm or serrated lesions harbouring dysplasia including traditional serrated adenomas) should be offered a one-off colonoscopic surveillance examination at 3 years (weak recommendation, low quality evidence, 90% agreement).

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Section: Detection and Resection Of Slsmentioning

confidence: 99%

British Society of Gastroenterology position statement on serrated polyps in the colon and rectum

East

Atkin

Bateman

et al. 2017

Gut

273

266

View full text Add to dashboard Cite

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“…First, all medico-economic estimations were based on a recurrence rate of 14% after WF piecemeal EMR. In a previous study of their group,5 they reported a higher recurrence rate (>30%) in lesions greater than 4 cm. This cut-off size is probably closer to the mean size of lesions generally resected by ESD in Western countries, and lesions between 2 and 4 cm could be good targets for hybrid resection techniques to reach R0 with more simple procedures 7 8.…”

mentioning

confidence: 78%

“…ESDs are associated with a high en bloc resection rate, low risk of recurrence and perfect pathological analysis 4. Defenders of piecemeal EMR point out the higher risk of ESD, the long duration of procedures, the discrepancies between Eastern and Western series, and the low proportion of lesions with superficial submucosal cancer 5. They also point out the good results of wide-field (WF)-EMR for complete eradication even when several sessions are needed 6.…”

mentioning

confidence: 99%

Endoscopic submucosal dissection or endoscopic mucosal resection for large colorectal laterally spreading lesions? Scientific and economic data are still lacking

Jacques

Chaussade

Ponchon

et al. 2018

Gut

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“…Prior studies that have evaluated risk factors for incomplete resection of large colonic polyps have included only specialized endoscopists at their center, while our study included general and specialist endoscopists, which may explain the higher rate of IR [13, 21]. Another reason may be our study’s higher percentage of polyps ≥ 40 mm, which is a known risk factor for IR.…”

Section: Discussionmentioning

confidence: 99%

Specialist Endoscopists Are Associated with a Decreased Risk of Incomplete Polyp Resection During Endoscopic Mucosal Resection in the Colon

et al. 2017

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Background Endoscopic experience is known to correlate with outcomes of endoscopic mucosal resection (EMR), particularly complete resection of the polyp tissue. Whether specialist endoscopists can protect against incomplete polypectomy in the setting of known risk factors for incomplete resection (IR) is unknown. Aims We aimed to characterize how specialist endoscopists may help to mitigate the risk of IR of large sessile polyps. Methods This is a retrospective cohort study of patients who underwent EMR at the University of Michigan from January 1, 2006, to November 15, 2015. The primary outcome was endoscopist-reported polyp tissue remaining at the end of the initial EMR attempt. Specialist endoscopists were defined as endoscopists who receive tertiary referrals for difficult colonoscopy cases and completed at least 20 EMR colonic polyp resections over the study period. Results A total of 257 patients with 269 polyps were included in the study. IR occurred in 40 (16%) cases. IR was associated with polyp size ≥ 40 mm [adjusted odds ratio (aOR) 3.31, 95% confidence interval (CI) 1.38–7.93], flat/laterally spreading polyps (aOR 2.61, 95% CI 1.24–5.48), and difficulty lifting the polyp (aOR 11.0, 95% CI 2.66–45.3). A specialist endoscopist performing the initial EMR was protective against IR, even in the setting of risk factors for IR (aOR 0.13, 95% CI 0.04–0.41). Conclusions IR is associated with polyp size ≥ 40 mm, flat and/or laterally spreading polyps, and difficulty lifting the polyp. A specialist endoscopist initiating the EMR was protective of IR.

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Endoscopic mucosal resection for large serrated lesions in comparison with adenomas: a prospective multicentre study of 2000 lesions

Abstract: ClinicalTrials.gov NCT01368289.

Cited by 118 publications

References 38 publications

British Society of Gastroenterology position statement on serrated polyps in the colon and rectum

British Society of Gastroenterology position statement on serrated polyps in the colon and rectum

Endoscopic submucosal dissection or endoscopic mucosal resection for large colorectal laterally spreading lesions? Scientific and economic data are still lacking

Specialist Endoscopists Are Associated with a Decreased Risk of Incomplete Polyp Resection During Endoscopic Mucosal Resection in the Colon

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