Safety of endoscopic mucosal resection (EMR) of large non-pedunculated colorectal adenomas in the elderly

Abstract

BackgroundEndoscopic mucosal resection (EMR) has been proven to be safe and effective for the treatment of colorectal adenomas. However, data are limited on the safety of this technique for large polyps and in elderly patients. Aims of our study were to examine the bleeding and perforation rates in patients with large non-pedunculated adenomas (≥20mm) and to evaluate the influence of size (≥40mm) and age (≥75 years) on the complication rates.MethodsIn this multicenter retrospective study, patients who underwent EMR of non-pedunculated adenomas ≥20mm between January 2012 and March 2016 were included. The demographics of the patients, the use of antithrombotic drugs, size of the polyps, type of resection, pathology report, occurrence of post-polypectomy bleeding, and perforation- and recurrence rate were collected.ResultsIn 343 patients, 412 adenomas were removed. Eighty patients (23.3%) were ≥75 years of age, 138 polyps (33.5%) were ≥40mm. Bleeding complications were observed in 28 cases (6.8%) and were found significantly more frequent in adenomas ≥40mm, independent of the use of antithrombotic therapy. Five perforations (1.2%) were described, not related to the size of the polyp. There was no significant difference in complication rates between patients <75 years and patients ≥75 years. Bleeding complications rates were significantly higher in patients receiving double antithrombotic therapy.ConclusionEMR is safe in elderly patients. EMR of adenomas of ≥40mm was associated with more bleeding complications. Future studies should address how the bleeding rates can be reduced in these patients, especially in those who use double antithrombotic treatment.

Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis

“…Focusing on postprocedural bleeding, rates ranging from 2.2% to 6.7% have been reported in the literature when using hot EMR for large polyps. 22,23 In our pooled analysis the postprocedural bleed rate was .5% for all polyps !10 mm and 0% when the analysis was restricted just to studies on EMR. Although randomized controlled trials would be required, if we do compare these results with previous meta-analyses on conventional polypectomy or EMR techniques, [24][25][26] CSP appears to be substantially safer.…”

“…25 The overall residual polyp rate for our study was 4.7% after cold EMR for polyps !10 mm, lower than the reported numbers in the literature. Focusing on lesions !20 mm, Bronsgeest et al 22 showed a recurrence rate of 18.8% after conventional EMR. In our pooled analysis the recurrence rate for polyps !20 mm was 15.4%.…”

“…Previously, Buchner et al 21 found the risk of immediate bleeding after conventional EMR (hot EMR) at 3.6% for mean polyp size of 23 mm. Bronsgeest et al 22 reported immediate bleeding rates of 4.6% for large polyps (mean, 32.3 mm) using conventional EMR. This higher rate of bleeding observed in this study is likely attributable to the use of antiplatelet and anticoagulant therapy by many study participants.…”

Underwater versus conventional endoscopic mucosal resection for small size non-pedunculated colorectal polyps: a randomized controlled trial

“…Since 2012, only one patient undergoing UEMR developed perforations, as described previously [ 27 ]. However, in a report on CEMR, the perforation rate ranged from 1.2 to 4.4% in patients who underwent CEMR [ 28 , 29 ]. These previous findings further confirm the safety of UEMR.…”

Quality of life and fear of cancer recurrence in T1 colorectal cancer patients treated with endoscopic or surgical tumor resection

“…7 In addition, colorectal surgery involves a significant risk of morbidity (30%) and even mortality (1%-5%), especially in the elderly population, [10][11][12] the main target group of screening programs. 13,14 On the contrary, therapeutic colonoscopies, including endoscopic resection of large colon polyps, 15,16 carry a low risk of morbidity and mortality and are therefore considered to be safe in the elderly. 17 Because an accurate weighing up of oncologic benefit versus the risk of treatmentrelated adverse events remains challenging, eliciting the patient's perspective becomes especially important.…”