The size, morphology, site, and access score predicts critical outcomes of endoscopic mucosal resection in the colon

Sidhu, Mayenaaz; Tate, David J.; Desomer, Lobke; Brown, Gregor J.; Hourigan, Luke F.; Lee, Eric Y.T.; Moss, Alan; Raftopoulos, Spiro; Singh, Rajvinder; Williams, Stephen J.; Zanati, Simon; Burgess, Nicholas G.; Bourke, Michael J.

doi:10.1055/s-0043-124081

Cited by 74 publications

(68 citation statements)

References 28 publications

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“…This study demonstrated that the local colon adenoma recurrence rate in our cohort of patients with ≥ 20-mm colon LSTs managed using cap-fitted colonoscopy with EMR and ablation of the resection edge with APC was low (4.5 %). This adenoma recurrence rate was much lower than 16.0 % to 32 % reported in the literature on traditional EMR for non-pedunculated polyps (▶ Table 3) [3,10,12,[19][20][21][22][23][24][25][26][27][28][29][30][31][32].…”

Section: Discussionmentioning

confidence: 84%

Cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate

et al. 2020

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Background and study aims Endoscopic mucosal resection (EMR) is increasingly used for the treatment of large colonic polyps (≥ 20 mm). A drawback of EMR is local adenoma recurrence. Therefore, we studied the impact of argon plasma coagulation (APC) of the EMR edge on local adenoma recurrence. Patients and methods This was a retrospective study of patients with laterally spreading tumors (LST) ≥ 20 mm, who underwent EMR from January 2009 to August 2018 and follow-up endoscopic assessment. A cap-fitted endoscope was used to assess completeness of resection by systematically inspecting the EMR defect for any macroscopic disease. This was followed by forced APC of the resection edge followed by clip closure of the defect. Surveillance colonoscopy was performed at 6 months after resection to detect recurrence. Results Two hundred forty-six patients met the inclusion criteria. Most were female (53 %) and white (80 %), with a Median age of 64 years. Median polyp size was 35 mm (interquartile range, 30–45 mm). Most polyps were located in the right colon (77 %) and were removed by piecemeal EMR (70 %). Eleven patients (5 %) had residual tumor at the resection site. Conclusions We observed low adenoma recurrence after argon plasma coagulation of the EMR edge with a cap fitted colonoscope in patients with LST ≥ 20 mm of the colon, which requires further validation in a randomized controlled study.

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Section: Discussionmentioning

confidence: 84%

Cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate

et al. 2020

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“…[5][6][7][8][9][10][11][12][13] Proximal polyp location has been consistently reported to increase the risk of delayed bleeding at least 2-fold. [12][13][14]29 Use of antiplatelet agents has been reported in some but not other studies. 13,14 Limited data suggest that intraprocedural bleeding and type of cautery setting may represent additional risk factors.…”

Section: Discussionmentioning

confidence: 99%

Clip Closure Prevents Bleeding After Endoscopic Resection of Large Colon Polyps in a Randomized Trial

et al. 2019

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BACKGROUND & AIMS: Bleeding is the most common severe complication after endoscopic mucosal resection of large colon polyps and is associated with significant morbidity and cost. We examined whether prophylactic closure of the mucosal defect with hemoclips after polyp resection reduces the risk of bleeding. METHODS: We performed a multicenter, randomized trial of patients with a large nonpedunculated colon polyp (!20 mm) at 18 medical centers in North America and Spain from April 2013 through October 2017. Patients were randomly assigned to groups that underwent endoscopic closure with a clip (clip group) or no closure (control group) and followed. The primary outcome, postprocedure bleeding, was defined as a severe bleeding event that required hospitalization, a blood transfusion, colonoscopy, surgery, or another invasive intervention within 30 days after completion of the colonoscopy. Subgroup analyses included postprocedure bleeding with polyp location, polyp size, or use of periprocedural antithrombotic medications. We also examined the risk of any serious adverse

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“…Adenomas (tubular, tubulovillous, villous, and serrated adenomas) are defined as benign tumors. Therefore, complete resection of these is possible unless there are residual lesions at the incised margin …”

Section: Assessment Of Curabilitymentioning

confidence: 99%

“…Therefore, complete resection of these is possible unless there are residual lesions at the incised margin. [148][149][150][151]…”

Section: Adenomamentioning

confidence: 99%

Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection

Tanaka

Kashida

Saito

et al. 2019

Digestive Endoscopy

275

292

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Suitable lesions for endoscopic treatment include not only early colorectal carcinomas but also several types of precarcinomatous adenomas. It is important to establish practical guidelines wherein preoperative diagnosis of colorectal neoplasia and selection of endoscopic treatment procedures are appropriately outlined and to ensure that actual endoscopic treatment is useful and safe in general hospitals when carried out in accordance with guidelines. In cooperation with the Japanese Society for Cancer of the Colon and Rectum, the Japanese Society of Coloproctology, and the Japanese Society of Gastroenterology, the Japan Gastroenterological Endoscopy Society compiled colorectal endoscopic submucosal dissection/endoscopic mucosal resection guidelines by using evidence‐based methods in 2014. The first edition of these guidelines was published 5 years ago. Accordingly, we have published the second edition of these guidelines based on recent new knowledge and evidence.

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The size, morphology, site, and access score predicts critical outcomes of endoscopic mucosal resection in the colon

Cited by 74 publications

References 28 publications

Cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate

Cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate

Clip Closure Prevents Bleeding After Endoscopic Resection of Large Colon Polyps in a Randomized Trial

Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection

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