Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study

Abstract

NCT01368289.

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

“…3 Indeed, endoscopic mucosal resection (EMR) is an effective, cheaper and safer way of managing LNPCPs both compared with endoscopic submucosal disssection (ESD) and with surgery. [4][5][6] Residual and/or recurrent adenoma (RRA) is the main drawback of this technique. In most cases an early follow-up within the first six months is indicated.…”

Predictive factors for technically difficult endoscopic submucosal dissection in large colorectal tumors

“…Further, the colon has a thinner wall than the stomach, which can result in a high risk of perforation (5). Recently, some new methods have been introduced to overcome these drawbacks, such as hybrid ESD, circumferential incision accompanied by snaring (precutting EMR), and wide-field (WF) EMR (6)(7)(8). However, for large tumors, ESDS, cutting EMR, and WF EMR are not suitable because of technical demanding with complete histopathological evaluation (6).…”

Endoscopic mucosal resection of large colorectal adenomas: Only for expert centers?

“…7 On the other hand even in expert centers, higher rates of remnant/ residual adenomas may occur, as in the recent Australian study mentioned above. 9 In this paper, increased lesion size, use of APC and intra-procedural bleeding were significant risk factors. Another study, by a single endoscopist at a tertiary center, reveals residual tissue following piece-meal EMR in 38% of cases, with polyp size being a significant risk factor for recurrence.…”

“…8 Another recent large series from Australia included 1000 successful colorectal EMRs: 80% had an early follow-up with a 16% rate of residual/recurrent adenomas, even if mostly minimal; and of the 670 cases with a normal first control colonoscopy, only 426 had a second follow-up within the study, revealing a 4% recurrence rate. 9 The price for the high overall effectiveness of colorectal EMR (98% in the Australian study) is, therefore, the consequent performance of several follow-up colonoscopies within the first 2-3 years. The importance of follow-up, perhaps even as a quality indicator of colonoscopy with polypectomy, cannot be stressed enough.…”

“…9 Those may usually be ablated easily in almost all cases, leading to low late-recurrence rates, during further follow up. 7,9 The comparably high recurrence rates during further follow-up sessions, as found by Barendse et al, 11 may be explained by insufficient imaging, poor bowel preparation or localization behind folds, as suggested by the authors. In addition, lower experience in recognizing and treating remnants or recurrences at the polypectomy scar may have also played a role.…”