Recurrence After Endoscopic Mucosal Resection: Early and Late Incidence, Treatment Outcomes, and Outcomes in Non-Overt (Histologic-Only) Recurrence

Rahyel, Ahmed El; Abdullah, Nor Azizan; Love, Emma J; Vemulapalli, Krishna C.; Rex, Douglas K.

doi:10.1053/j.gastro.2020.10.039

Cited by 14 publications

(15 citation statements)

References 8 publications

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“…Furthermore, we did not identify reports of this occurrence in the medical literature. 4 There are several potential explanations. First, although the histologic and molecular analyses favored colonic origin, possibly the tumor originated at another site.…”

Section: Discussionmentioning

confidence: 99%

“… 3 Rarely, follow-up at the EMR site shows cancer development, although pathologic assessment of the tissue obtained at the original resection did not show cancer. 4 , 5 In 2 large series of follow-up at EMR, the incidence of cancer at the resection site has been 0.17% and 0.25%. 4 , 5 We describe an even more rare occurrence, development of metastatic cancer to the liver considered to have a likely colon primary after EMR of benign colorectal lesions.…”

Section: Introductionmentioning

confidence: 99%

“… 4 , 5 In 2 large series of follow-up at EMR, the incidence of cancer at the resection site has been 0.17% and 0.25%. 4 , 5 We describe an even more rare occurrence, development of metastatic cancer to the liver considered to have a likely colon primary after EMR of benign colorectal lesions. There was no evidence of intracolonic cancer by repeat colonoscopy when the patient presented with metastatic cancer.…”

Section: Introductionmentioning

confidence: 99%

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Metastatic Cancer of Apparent Colon Origin With No Intraluminal Cancer After Resection of Colorectal Lateral Spreading Lesions

Lee

Vemulapalli

et al. 2021

ACG Case Rep J

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Metastatic Cancer of Apparent Colon Origin With No Intraluminal Cancer After Resection of Colorectal Lateral Spreading Lesions

Lee

Vemulapalli

et al. 2021

ACG Case Rep J

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“…We used the section of the database from 2000 through 2015 because the database was complete for both the pedunculated index lesions and non-pedunculated index lesions. To conserve resources we did not update the database with synchronous after reporting rates of synchronous lesions for nonpedunculated lesions [1] Large nonpedunculated polyps were removed by endoscopic mucosal resection (EMR) and the scar site was examined after 6 months [7][8][9][10][11]. Due to the technically challenging removal of some large non-pedunculated polyps, the removal of synchronous lesions was often deferred until the first follow-up surveillance [1].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Prevalence of synchronous neoplasia in patients with large pedunculated colorectal polyps

2022

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Background and study aims: Large (≥ 20 mm) non-pedunculated colorectal lesions have high rates of synchronous neoplasia and advanced neoplasia. Synchronous neoplasia prevalence in patients with large pedunculated lesions is uncertain. We describe synchronous neoplasia in patients with large pedunculated colorectal polyps, using a cohort of patients with large non-pedunculated lesions as controls. Patients and methods: Retrospective assessment of a prospectively recorded database listing synchronous findings in patients with ≥ 20 mm colorectal lesions referred to a tertiary center for endoscopic resection. Results: At least 1 synchronous precancerous lesion was identified in 66 of 78 (84.6%, 95% CI 74.9-91.1) patients with large pedunculated lesions and 726 of 814 (89.2%, 95% CI 87.1-91.3) patients with large non-pedunculated lesions. Patients with large pedunculated lesions had mean 4.8 synchronous conventional adenomas, and 56% had ≥ 1 synchronous high-risk lesion (advanced adenoma or advanced serrated lesion), 49% had ≥ 1 synchronous advanced conventional adenoma, and 19% had a synchronous neoplastic lesion ≥ 20 mm. Patients with large pedunculated index lesions had comparable rates of synchronous polyps, adenomas, and sessile serrated lesions, and had higher rates of synchronous adenomas with villous elements (26.9%, 95% CI 18.3-37.7 vs. 15.6%, 95% CI 13.3-18.3; p = 0.01) as well as synchronous pedunculated polyps compared to patients with non-pedunculated index lesions (33.3%, 95% CI 23.8-44.4 vs. 9.5%, 95% CI 7.6-11.7; p < 0.001). Conclusion: In patients with large (≥ 20 mm) pedunculated colorectal lesions, rates of synchronous neoplasia and advanced synchronous neoplasia are high and comparable to or higher than rates of synchronous neoplasia in patients with large (≥ 20 mm) nonpedunculated colorectal lesions.

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“…After six months, patients presented for follow-up surveillance colonoscopies to assess the EMR scar defects for residual lesion. Endoscopically normal scar defects are biopsied [10], and either endoscopically visible polyp or polyp detected histologically by biopsy were counted as residual polyp.…”

Section: Follow-upmentioning

confidence: 99%

Outcomes of large colorectal polyp endoscopic resections during small audience live endoscopy events with endoscopist at their home endoscopy unit

Rahyel

Rex

2022

Endosc Int Open

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Background and study aims: Live endoscopy courses are popular. The safety of performing live endoscopy has been questioned. In this study, we compared outcomes of large colorectal polyp resections during live endoscopy events (LEE) (with a small audience of 2-5 physicians) to those removed during standard procedure days (SPD) (without an audience). All procedures were performed at the endoscopist’s home unit. Methods: Retrospective assessment of the adverse event and recurrence rates for large (≥ 20 mm) non-pedunculated colorectal lesions removed during LEEs. Logistic regression was used to assess whether presence of an audience predicted worse outcomes. Results: From January 2017 to May 2021, 317 lesions were removed with a live audience and 866 were removed on SPD. Polyp pathology and procedure length were similar in both groups. There were 16 (5.0%) total adverse events in the LEE group and 30 (3.4%) in the SPD group (p = 0.224). The majority in both groups were delayed hemorrhage. There were 2 (0.6%) perforations in the LEE and 3 (0.3%) in the SPD group. Increasing polyp size was associated with more adverse events and higher recurrence. Increasing patient age predicted higher recurrence, and thermal injury of the resection margin predicted lower recurrence. There were no other predictors of adverse events or recurrence, including presence of a live audience. Conclusion: Removing large colorectal polyps with a small live audience did not increase adverse outcomes.

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Recurrence After Endoscopic Mucosal Resection: Early and Late Incidence, Treatment Outcomes, and Outcomes in Non-Overt (Histologic-Only) Recurrence

Cited by 14 publications

References 8 publications

Metastatic Cancer of Apparent Colon Origin With No Intraluminal Cancer After Resection of Colorectal Lateral Spreading Lesions

Metastatic Cancer of Apparent Colon Origin With No Intraluminal Cancer After Resection of Colorectal Lateral Spreading Lesions

Prevalence of synchronous neoplasia in patients with large pedunculated colorectal polyps

Outcomes of large colorectal polyp endoscopic resections during small audience live endoscopy events with endoscopist at their home endoscopy unit

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