Background and Aims
Effective interventions to prevent residual and/or recurrent adenoma (RRA) after EMR
of large sessile and laterally spreading colorectal lesions (LSL) are yet to be determined.
RRA may occur due to inconspicuous adenoma at the EMR margin. We aimed to determine
the efficacy and safety of extended EMR (X-EMR) compared with standard EMR (S-EMR).
Methods
A single-center post hoc analysis of LSL ≥20 mm referred for treatment was performed.
S-EMR was the standard sequential inject and resect method including a 1-mm to 2-mm
margin of normal mucosa around the lesion. With X-EMR, at least a 5-mm margin of normal
mucosa was excised. Patient and lesion characteristics and procedural outcomes were
recorded. The primary endpoint was RRA at first surveillance colonoscopy at 4 months.
Results
Between January 2009 and May 2011, 471 lesions (mean size, 37.9 mm) in 424 patients
were resected by S-EMR, and between January 2012 and December 2013, 448 lesions (mean
size, 39.1 mm) in 396 patients were resected by X-EMR. Resection was successful in
92.3% and 92.6% of referred lesions in the S-EMR and X-EMR groups, respectively (P = .978). X-EMR was independently associated with a higher risk of intraprocedural
bleeding (IPB) (odds ratio, 3.1; 95% confidence interval [CI], 2.0-5.0; P < .001) but not other adverse events. RRA was present in 39 of 333 patients (11.7%)
and 30 of 296 patients (10.1%) in the S-EMR and X-EMR groups, respectively (P = .15). X-EMR was not related to recurrence (hazard ratio, 0.8; 95% CI, 0.5-1.3;
P = .399).
Conclusions
X-EMR does not reduce RRA and increases the risk of IPB compared with S-EMR. Alternative
methods for the prevention of RRA are required.
Abbreviations:
CI (confidence interval), ESD (endoscopic submucosal dissection), HGD (high-grade dysplasia), IPB (intraprocedural bleeding), LGD (low-grade dysplasia), LSL (large and laterally spreading lesion), RRA (residual or recurrent adenoma), SC1 (surveillance colonoscopy number one), SD (standard deviation), S-EMR (standard EMR), SMIC (submucosal invasive cancer), SSA/P (sessile serrated adenoma/polyp), X-EMR (extended EMR)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 14, 2016
Accepted:
May 4,
2016
Received:
November 18,
2015
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Dr Farzan Bahin was supported by a grant from the National Health and Medical Research Council of Australia (NHMRC). There was no influence from the NHMRC on study design or conduct, data collection and management, analysis, interpretation, preparation, and review or approval of the manuscript.
If you would like to chat with an author of this article, you may contact Dr Bourke at [email protected]
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Copyright © 2016 by the American Society for Gastrointestinal Endoscopy
